Provider Demographics
NPI:1861629586
Name:POWERS, SARAH BETH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:POWERS
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 1:18911 PORTLAND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1630
Mailing Address - Country:US
Mailing Address - Phone:503-655-8471
Mailing Address - Fax:503-722-6821
Practice Address - Street 1:9300 SE 91ST AVE
Practice Address - Street 2:STE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-3749
Practice Address - Country:US
Practice Address - Phone:503-261-1171
Practice Address - Fax:503-253-5989
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500648397Medicaid