Provider Demographics
NPI:1699977801
Name:DENHAM, SEAN C (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:C
Last Name:DENHAM
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN3610207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DU770OtherBCBS
TX204858901Medicaid
TX75-0818167-048OtherTRICARE
TX750818167022OtherTRICARE
TX8DD814OtherBCBS
TXP00729843OtherRAIL ROAD
LA07803Medicaid
TX752616977-002OtherTRICARE
TX8AP488OtherBCBS
TXP00729838OtherRAILROAD MCR
TXP01304443OtherRAIL ROAD
TX8CA736OtherBCBS
TX75-2616977-028OtherTRICARE
TX750818167-015OtherTRICARE
TX750818167-044OtherTRICARE
TX204858903Medicaid
TX204858904Medicaid
TX752616977-01OtherTRICARE
TX205858902Medicaid
TX751976930-005OtherTRICARE
TXP00729843OtherRAILROAD MCR
TX75-2616977-028OtherTRICARE
TX204858904Medicaid
LA07803Medicaid
TX8L14828Medicare Oscar/Certification