Provider Demographics
NPI:1396796504
Name:GUPTON, SEAN S (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:S
Last Name:GUPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-877-5153
Mailing Address - Fax:
Practice Address - Street 1:2845 SIENA HEIGHTS DR STE 1100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4161
Practice Address - Country:US
Practice Address - Phone:808-667-6161
Practice Address - Fax:808-667-6166
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13784207Q00000X
NV17270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH13328Medicare UPIN