Provider Demographics
NPI:1962461442
Name:SHERRY, SCOTT P (PAC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:P
Last Name:SHERRY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N GRAHAM
Mailing Address - Street 2:STE 580
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-2003
Mailing Address - Country:US
Mailing Address - Phone:503-528-0704
Mailing Address - Fax:503-528-0708
Practice Address - Street 1:501 N GRAHAM
Practice Address - Street 2:STE 580
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2003
Practice Address - Country:US
Practice Address - Phone:503-528-0704
Practice Address - Fax:503-528-0708
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00859363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical