Provider Demographics
NPI:1881645596
Name:DORADO, SEAN PAUL ROYAL (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN PAUL
Middle Name:ROYAL
Last Name:DORADO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746093
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6093
Mailing Address - Country:US
Mailing Address - Phone:773-352-1517
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:2720 SOUTH 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-4701
Practice Address - Country:US
Practice Address - Phone:520-475-5418
Practice Address - Fax:520-300-8034
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3038363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85098Medicare ID - Type UnspecifiedMEDICARE
AZQ27214Medicare UPIN