Healthcare Provider Details

I. General information

NPI: 1891245999
Provider Name (Legal Business Name): SEAN MCHUGH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E 12TH ST
THE DALLES OR
97058-3213
US

IV. Provider business mailing address

1620 E 12TH ST
THE DALLES OR
97058-3213
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-9151
  • Fax:
Mailing address:
  • Phone: 541-296-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA180171
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: