Provider Demographics
NPI:1033283627
Name:RABACAL, SEAN T (PA-C)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:T
Last Name:RABACAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74B CENTENNIAL LOOP STE 300
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7925
Mailing Address - Country:US
Mailing Address - Phone:541-686-3791
Mailing Address - Fax:541-686-3795
Practice Address - Street 1:74B CENTENNIAL LOOP STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7925
Practice Address - Country:US
Practice Address - Phone:541-686-3791
Practice Address - Fax:541-686-3795
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00651363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R133962Medicare PIN
S86287Medicare UPIN