Sullivan, Scot A

Sullivan, Scot A is an individual health care provider with primary practice located at 10305 Sw Park Way Ste 203 , Portland OR 97225-5033. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Sullivan, Scot A can be contacted via phone (503) 223-8333.

Contact Information

Primary practice address
10305 Sw Park Way Ste 203 Portland OR 97225-5033
Phone: (503) 223-8333
Fax: (503) 595-8160
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 20157 Oklahoma
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X MD21723 Oregon

Profile Details

NPI number 1164481230
LBN Legal business name Sullivan, Scot A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 18th, 2006
Last updated Sep 17th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164481230 NPPES
Oregon Other 134409 GROUP PIN
Oregon MEDICAID 100102160B GROUP PIN

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