Provider Demographics
NPI:1073208476
Name:LOUDERBACK, SARAH (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LOUDERBACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-2709
Mailing Address - Country:US
Mailing Address - Phone:479-461-4222
Mailing Address - Fax:
Practice Address - Street 1:5310 E 31ST ST STE 901
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5012
Practice Address - Country:US
Practice Address - Phone:918-236-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program