Provider Demographics
NPI:1912130006
Name:SEAN R. WHITE, MD, PS
Entity type:Organization
Organization Name:SEAN R. WHITE, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-532-1950
Mailing Address - Street 1:1100 BASICH BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1066
Mailing Address - Country:US
Mailing Address - Phone:360-532-1950
Mailing Address - Fax:360-537-1177
Practice Address - Street 1:1100 BASICH BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1066
Practice Address - Country:US
Practice Address - Phone:360-532-1950
Practice Address - Fax:360-537-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60082203261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care