Provider Demographics
NPI:1306013776
Name:LEITZ, SARAH JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JANE
Last Name:LEITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3804
Mailing Address - Country:US
Mailing Address - Phone:617-894-2306
Mailing Address - Fax:
Practice Address - Street 1:1700 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3804
Practice Address - Country:US
Practice Address - Phone:971-278-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD154242207R00000X
WA60632956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine