Healthcare Provider Details

I. General information

NPI: 1104803691
Provider Name (Legal Business Name): SARAH LYNN AGSTEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 NW MEDICAL PARK DR
ROSEBURG OR
97471-5510
US

IV. Provider business mailing address

2508 NW MEDICAL PARK DR
ROSEBURG OR
97471-5510
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-5225
  • Fax: 541-673-5781
Mailing address:
  • Phone: 541-673-5225
  • Fax: 541-673-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO19873
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO19873
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: