Healthcare Provider Details

I. General information

NPI: 1295098168
Provider Name (Legal Business Name): SEAN DANIEL ARREDONDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 NE REVERE AVE STE 100
BEND OR
97701-4189
US

IV. Provider business mailing address

431 NE REVERE AVE STE 100
BEND OR
97701-4189
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-3223
  • Fax: 541-330-2499
Mailing address:
  • Phone: 541-312-3223
  • Fax: 541-330-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD230996
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberR7650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: