Individual
SEAN M SCEARCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
(918) 453-1234
(918) 453-9107
Mailing address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
(918) 453-1234
(918) 453-9107
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
869
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100108530A
—
OK
05
—
200000030A
—
OK
01
—
400522239
MEDICARE GROUP PTAN
OK
01
—
DA5295
RAILROAD MEDICARE GROUP
OK
01
—
P00299307
RAILROAD MEDICARE PIN
OK
Enumeration date
10/25/2005
Last updated
11/14/2012
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