1861629586 NPI number — SARAH BETH POWERS M.D.

Table of content: KELLY DUNBAR (NPI 1164237327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861629586 NPI number — SARAH BETH POWERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWERS
Provider First Name:
SARAH
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861629586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18911 PORTLAND AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
GLADSTONE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97027-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-655-8471
Provider Business Mailing Address Fax Number:
503-722-6821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 SE 91ST AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97086-3749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-261-1171
Provider Business Practice Location Address Fax Number:
503-253-5989
Provider Enumeration Date:
06/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD157356 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500648397 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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