Provider Demographics
NPI:1689027328
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
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-637-9522
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-0711
Mailing Address - Country:US
Mailing Address - Phone:360-637-9522
Mailing Address - Fax:
Practice Address - Street 1:1812 SUMNER AVE STE C
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4602
Practice Address - Country:US
Practice Address - Phone:360-637-9522
Practice Address - Fax:360-637-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60082203261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care