Provider Demographics
NPI:1790937613
Name:SIMONS, SARAH CHRISTINE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:CHRISTINE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CHRISTINE
Other - Last Name:FLEISCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9555 SW BARNES RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6663
Mailing Address - Country:US
Mailing Address - Phone:503-297-7403
Mailing Address - Fax:503-384-9908
Practice Address - Street 1:9555 SW BARNES RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6663
Practice Address - Country:US
Practice Address - Phone:503-297-7403
Practice Address - Fax:503-384-9908
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05213363AS0400X
ORPA165017363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00975252OtherRAILROAD MEDICARE
TXTXB136809Medicare PIN
TX284674301Medicaid