Basic Information
| Provider Information | |||||||||
| NPI: | 1750544243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPETTEL | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPETTEL ALIYAR | ||||||||
| OtherFirstName: | SARA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | SUITE 663 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032971078 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | SUITE 663 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032971078 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD161428 | OR | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.