Basic Information
| Provider Information | |||||||||
| NPI: | 1417446246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARDIS | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | CARTER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 GRANT ST SUITE 600 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703103406 | ||||||||
| FaxNumber: | 8889654615 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 GRANT ST SUITE 600 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703103406 | ||||||||
| FaxNumber: | 8889654615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2018 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | DR.0068431 | CO | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 0102206098 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.