Healthcare Provider Details

I. General information

NPI: 1508184763
Provider Name (Legal Business Name): SARAH FITZMAURICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N INTERSTATE AVE
PORTLAND OR
97227-1106
US

IV. Provider business mailing address

500 NE MULTNOMAH ST FL 11
PORTLAND OR
97232-2023
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 800-813-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA118271
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA118271
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD177019
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: