Healthcare Provider Details

I. General information

NPI: 1154662849
Provider Name (Legal Business Name): SEAN L STEWARD, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 PACIFIC AVE
FOREST GROVE OR
97116-2224
US

IV. Provider business mailing address

3838 PACIFIC AVE
FOREST GROVE OR
97116-2224
US

V. Phone/Fax

Practice location:
  • Phone: 503-992-0288
  • Fax: 503-359-4724
Mailing address:
  • Phone: 503-992-0288
  • Fax: 503-359-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number260204-95
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number12202-001
License Number StateOR

VIII. Authorized Official

Name: MS. THERESE MARIE GORMAN-STEWARD
Title or Position: ADMINISTRATOR
Credential: MA
Phone: 503-992-0288