Provider Demographics
NPI:1104803691
Name:AGSTEN, SARAH LYNN (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:AGSTEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 NW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5510
Mailing Address - Country:US
Mailing Address - Phone:541-673-5225
Mailing Address - Fax:541-673-5781
Practice Address - Street 1:2508 NW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5510
Practice Address - Country:US
Practice Address - Phone:541-673-5225
Practice Address - Fax:541-673-5781
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO19873208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151210Medicaid
430503101OtherBCBS HMO
OR804731000OtherBCBS PPO
430503101OtherBCBS HMO
OR804731000OtherBCBS PPO