Provider Demographics
NPI:1437117413
Name:MCELROY, SARAH T (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:T
Last Name:MCELROY
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 1:8495 CRATER LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-3011
Mailing Address - Country:US
Mailing Address - Phone:541-826-2111
Mailing Address - Fax:541-830-3502
Practice Address - Street 1:8495 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-3011
Practice Address - Country:US
Practice Address - Phone:541-826-2111
Practice Address - Fax:541-830-3502
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD113066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1124042452OtherVETERANS ADMINISTRATION
MO205034200Medicaid
MO205034200Medicaid
MOP00430571Medicare PIN
MO109011950Medicare PIN
OR1124042452OtherVETERANS ADMINISTRATION
MO080159183Medicare PIN