Basic Information
| Provider Information | |||||||||
| NPI: | 1750574794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRISON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | DODGE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5579 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977085579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417065935 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61250 SE COOMBS PL | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417065935 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME 81343 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD175489 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 500711860 | 05 | OR | MEDICAID |