Provider Demographics
NPI:1083657563
Name:SARMIENTO, DAVID KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEITH
Last Name:SARMIENTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 NW ANDERSON CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8668
Mailing Address - Country:US
Mailing Address - Phone:503-312-6364
Mailing Address - Fax:
Practice Address - Street 1:2819 NW ANDERSON CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-8668
Practice Address - Country:US
Practice Address - Phone:503-312-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25042207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275206Medicaid
I05068Medicare UPIN
OR118895Medicare ID - Type Unspecified