Provider Demographics
NPI:1982894598
Name:GRAHAM, SEAN K (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:K
Last Name:GRAHAM
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 1:5408 FLANDERS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9168
Mailing Address - Country:US
Mailing Address - Phone:225-769-5554
Mailing Address - Fax:225-761-3334
Practice Address - Street 1:5408 FLANDERS DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9168
Practice Address - Country:US
Practice Address - Phone:225-769-5554
Practice Address - Fax:225-761-3334
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200855207LP2900X
LA200855208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1090875Medicaid