Provider Demographics
NPI:1548507965
Name:SMITH, SEAN WOODSON (PA-C)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:WOODSON
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:WOODSON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2971 W ELLIOT RD
Mailing Address - Street 2:STE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1636
Mailing Address - Country:US
Mailing Address - Phone:480-733-5483
Mailing Address - Fax:480-659-8366
Practice Address - Street 1:2971 W ELLIOT RD
Practice Address - Street 2:STE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-733-5483
Practice Address - Fax:480-659-8366
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5082363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical