MEDICARE: SARAH LYNN AGSTEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	DO19873	OR
2	207Q00000X	Family Medicine Physician	DO19873	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	430503101	OTHER		BCBS HMO
3	804731000	OTHER	OR	BCBS PPO

General Provider Information

NPI Number	:	1104803691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LYNN AGSTEN DO

Provider Business Mailing Address
First Line	:	2508 NW MEDICAL PARK DR
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5510
Country	:	US
Telephone Number	:	541-673-5225
Fax Number	:	541-673-5781

Provider Business Practice Location Address
First Line	:	2508 NW MEDICAL PARK DR
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5510
Country	:	US
Telephone Number	:	541-673-5225
Fax Number	:	541-673-5781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/08/2020

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Directions to “ SARAH LYNN AGSTEN DO” Practice Location

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