Individual
SEAN LUKE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10180 SE SUNNYSIDE RD OFC EGS, CLACKAMAS, OR 97015-8970
(503) 813-2000
Mailing address
10180 SE SUNNYSIDE RD OFC, CLACKAMAS, OR 97015-8970
(503) 813-2000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
63579
MN
208600000X
Surgery Physician
73695-20
WI
208600000X
Surgery Physician
Primary
MD201352
OR
208600000X
Surgery Physician
MD47700
IA
208600000X
Surgery Physician
MD61103323
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2015
Last updated
12/02/2021
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