Individual
KENT MICHAEL SANDQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
335 SW 13TH ST, ONTARIO, OR 97914-4547
(541) 889-8410
(541) 889-8093
Mailing address
335 SW 13TH ST, ONTARIO, OR 97914-4547
(541) 889-8410
(541) 889-8093
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01105
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500636562
—
OR
01
—
PA01105
LICENSE
OR
Enumeration date
12/14/2006
Last updated
01/13/2015
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