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General NPI Number Information
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NPI Number | 1740644913
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Entity Type | Individual
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Provider Name | SEAN S BENNETT D.O
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Gender | Male
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 2801 N GANTENBEIN AVE
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City | PORTLAND
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State | OR
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Zip | 97227-1623
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Country | US
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Telephone | 503-413-8949
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3777
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City | PORTLAND
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State | OR
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Zip | 97208-3777
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 79056
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DO189680
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 283754
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 22399
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License Number State | ND
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