Provider Demographics
NPI:1912911009
Name:COUGHLIN, SEAN J (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:J
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:11714 WILSON PARK AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4006
Practice Address - Country:US
Practice Address - Phone:737-247-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103581806Medicaid
110167980OtherRETIRED RAILROAD MEDICARE
TX103581805Medicaid
110167980OtherRETIRED RAILROAD MEDICARE
TX103581806Medicaid
TX103581805Medicaid