Provider Demographics
NPI:1497240121
Name:SCULL, DORIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:SCULL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:ANN
Other - Last Name:SCULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3303 S BOND AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-346-1500
Mailing Address - Fax:503-494-8671
Practice Address - Street 1:3303 SW BOND AVE STE 10
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-346-1500
Practice Address - Fax:503-494-8671
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA195766363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty