Provider Demographics
NPI:1255302725
Name:SANDERS, RIVKA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:RIVKA
Middle Name:ANN
Last Name:SANDERS
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 1:258 A ST STE 1-133
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1947
Mailing Address - Country:US
Mailing Address - Phone:541-482-0061
Mailing Address - Fax:888-869-7645
Practice Address - Street 1:540 CATALINA DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1605
Practice Address - Country:US
Practice Address - Phone:541-482-0061
Practice Address - Fax:888-869-7645
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD151361207Q00000X
OH64128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227698Medicaid
ORR159024Medicare PIN
OR227698Medicaid
OH0906130Medicaid