Provider Demographics
NPI:1972595221
Name:EARLY, SEAN D (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:D
Last Name:EARLY
Suffix:
Gender:
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 9409
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9409
Mailing Address - Country:US
Mailing Address - Phone:805-687-2424
Mailing Address - Fax:805-687-0885
Practice Address - Street 1:133 W SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2543
Practice Address - Country:US
Practice Address - Phone:805-641-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60507207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972595221OtherINDIVIDUAL NPI
CA1720259575OtherGROUP NPI
CA00A605070Medicaid
CA1972595221OtherINDIVIDUAL NPI
CA1720259575OtherGROUP NPI
CA00A605070Medicaid