Provider Demographics
NPI:1609887819
Name:TRASK, SARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:TRASK
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 1:620 NW11TH ST, SUITE M201
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-9531
Mailing Address - Country:US
Mailing Address - Phone:541-289-4118
Mailing Address - Fax:541-667-3484
Practice Address - Street 1:1050 W ELM AVE STE 110
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2713
Practice Address - Country:US
Practice Address - Phone:541-567-2995
Practice Address - Fax:541-567-7720
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19116207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061528Medicaid
061528OtherMARION POLK CHP
111646OtherWORKERS COMPENSATION
WA8175150Medicaid
F76311OtherPROVIDENCE
015388000OtherBCBS
A040OtherCHAMPUS
F76311OtherGROUP HEALTH
M400719OtherPACIFIC SOURCE
CAXPY188979Medicaid
F76311OtherPROVIDENCE