Individual
MR. JOHNNY WAYNE SINISCAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICANS ASSISTANT
Contact information
Practice address
10100 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 571-8278
(503) 571-2740
Mailing address
20770 SW SANDRA LN, BEAVERTON, OR 97006-1846
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
OR PA 00079
OR
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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