Provider Demographics
NPI:1407981814
Name:SAULTZ, ALISHA B (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:B
Last Name:SAULTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:B
Other - Last Name:KETNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-659-4777
Mailing Address - Fax:503-652-5223
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:PLAZA 2, SUITE 25
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1582
Practice Address - Country:US
Practice Address - Phone:503-659-4988
Practice Address - Fax:503-353-1234
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO126006207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500616998Medicaid
ORR149493Medicare PIN