Provider Demographics
NPI:1598851552
Name:HOLTZMAN, SALLY JANE (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JANE
Last Name:HOLTZMAN
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 1:501 N GRAHAM
Mailing Address - Street 2:#445
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-284-5220
Mailing Address - Fax:503-249-2118
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:#445
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-284-5220
Practice Address - Fax:503-249-2118
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20770207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151029Medicaid
G60260Medicare UPIN
0000105588Medicare ID - Type Unspecified