Individual
MR. SEAN ANTHONY SUTTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A - C.
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2861
AZ
363A00000X
Physician Assistant
Primary
PA151054
OR
363A00000X
Physician Assistant
PA60053080
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00887738
MEDICARE RAILROAD
OR
01
—
1740287457
RAILROAD MEDICARE
—
01
—
2861
STATE LICENSE
AZ
05
—
500621825
—
OR
05
—
965519
—
AZ
Enumeration date
07/07/2005
Last updated
01/29/2022
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