Healthcare Provider Details

I. General information

NPI: 1417151382
Provider Name (Legal Business Name): SARA MURDICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 NW GREENBRIER PKWY STE 111
BEAVERTON OR
97006-7374
US

IV. Provider business mailing address

15455 NW GREENBRIER PKWY STE 111
BEAVERTON OR
97006-7374
US

V. Phone/Fax

Practice location:
  • Phone: 503-531-3434
  • Fax: 503-645-4544
Mailing address:
  • Phone: 503-531-3434
  • Fax: 503-645-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD157316
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD157316
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: