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1740287457

NPI Code Detail

MEDICARE: MR. SEAN ANTHONY SUTTLE P.A - C.

MEDICARE: MR. SEAN ANTHONY SUTTLE P.A - C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA151054	OR
2	363A00000X	Physician Assistant	PA60053080	WA
3	363A00000X	Physician Assistant	2861	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00887738	OTHER	OR	MEDICARE RAILROAD
2	1740287457	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	2861	OTHER	AZ	STATE LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740287457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN ANTHONY SUTTLE P.A - C.

Provider Business Mailing Address
First Line	:	1501 NE MEDICAL CENTER DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6051
Country	:	US
Telephone Number	:	541-382-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	61250 SE COOMBS PL
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3704
Country	:	US
Telephone Number	:	541-706-5930
Fax Number	:	541-706-5931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/01/2026

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Directions to “ MR. SEAN ANTHONY SUTTLE P.A - C.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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