Provider Demographics
NPI:1316068919
Name:HARPER, SEAN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:SCOTT
Last Name:HARPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:503-655-2404
Mailing Address - Fax:503-655-1581
Practice Address - Street 1:1105 PORTLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2170
Practice Address - Country:US
Practice Address - Phone:503-655-2404
Practice Address - Fax:503-655-1581
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD126227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500612468Medicaid
ORR149389OtherMEDICARE PTAN