Provider Demographics
NPI:1225113731
Name:SAKS, SELDON KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:SELDON
Middle Name:KEITH
Last Name:SAKS
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 1:19300 SW BOONES FERRY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9086
Mailing Address - Country:US
Mailing Address - Phone:503-661-2844
Mailing Address - Fax:503-612-8445
Practice Address - Street 1:19300 SW BOONES FERRY RD STE 5
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9086
Practice Address - Country:US
Practice Address - Phone:503-612-8448
Practice Address - Fax:503-612-8445
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR57687Medicaid
ORK0168 01OtherPACIFIC SOURCE HEALTH PLA
OR0000BHXDXMedicare ID - Type Unspecified
OR57687Medicaid