Provider Demographics
NPI:1801916788
Name:SELLERS, BRIAN LEE (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7085 SYDNEY CURV
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3509
Mailing Address - Country:US
Mailing Address - Phone:334-246-4774
Mailing Address - Fax:833-963-2439
Practice Address - Street 1:7085 SYDNEY CURV
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3509
Practice Address - Country:US
Practice Address - Phone:334-246-4774
Practice Address - Fax:833-963-2439
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054665208600000X
MS205642086S0129X
ALDO.13502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9952406OtherAETNA
MS1496991OtherCIGNA
MS04875221Medicaid
MSP00740263OtherRAILROAD MEDICARE
MS6030889OtherHEALTHSPRING
MSP00740263OtherRAILROAD MEDICARE