Provider Demographics
NPI:1194715730
Name:SCEARCE, SEAN M (PA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:SCEARCE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1203 E ROSS BYP
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4133
Mailing Address - Country:US
Mailing Address - Phone:918-453-1234
Mailing Address - Fax:918-453-9107
Practice Address - Street 1:1203 E ROSS BYP
Practice Address - Street 2:SUITE A
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4133
Practice Address - Country:US
Practice Address - Phone:918-453-1234
Practice Address - Fax:918-453-9107
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK869363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108530AMedicaid
OKP00299307OtherRAILROAD MEDICARE PIN
OKDA5295OtherRAILROAD MEDICARE GROUP
OK400522239OtherMEDICARE GROUP PTAN
OK200000030AMedicaid
OK100108530AMedicaid
OK400522239OtherMEDICARE GROUP PTAN