Individual
SEAN PATRICK TUSHLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4805 NE GLISAN ST, STE BG05, PORTLAND, OR 97213-2933
(503) 215-2393
(503) 215-6918
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD24128
OR
208M00000X
Hospitalist Physician
Primary
MD24128
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376576983
—
WA
05
—
234445
—
OR
01
—
P00465307
RR MEDICARE (PH&S)-PMG
OR
Enumeration date
07/08/2006
Last updated
10/20/2020
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