Individual
MR. SEAN SIMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10330 SE 32ND AVE STE 205, MILWAUKIE, OR 97222-6594
(503) 513-8950
(503) 513-8951
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA170896
OR
363A00000X
Physician Assistant
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500682764
—
OR
01
—
P01502233
RAILROAD MEDICARE
OR
Enumeration date
01/21/2015
Last updated
10/05/2020
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