Provider Demographics
NPI:1548250129
Name:MCDONALD, SEAN P (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2725 JAMES SANDERS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8401
Mailing Address - Country:US
Mailing Address - Phone:270-554-5114
Mailing Address - Fax:270-554-5021
Practice Address - Street 1:2725 JAMES SANDERS BLVD
Practice Address - Street 2:STE A
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8405
Practice Address - Country:US
Practice Address - Phone:270-554-5114
Practice Address - Fax:270-215-4834
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2019-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY36051207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64024797Medicaid
1327010Medicare ID - Type Unspecified
KY64024797Medicaid
H26526Medicare UPIN