Provider Demographics
NPI:1609018878
Name:MCCULLY, SEAN PATRICK (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:MCCULLY
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 WEST 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402
Mailing Address - Country:US
Mailing Address - Phone:541-988-6200
Mailing Address - Fax:541-988-6215
Practice Address - Street 1:3154 WEST 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-988-6200
Practice Address - Fax:541-988-6215
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1764782086S0127X, 208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program