Provider Demographics
NPI:1811970346
Name:BECKER, SARA K (MD)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:K
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MR
Other - First Name:HERBERT
Other - Middle Name:
Other - Last Name:FORESMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-659-4777
Mailing Address - Fax:503-652-5223
Practice Address - Street 1:3033 SE MONROE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6636
Practice Address - Country:US
Practice Address - Phone:503-659-4988
Practice Address - Fax:503-659-4730
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268508Medicaid
ORC92642Medicare UPIN
OR268508Medicaid