Provider Demographics
NPI:1124261862
Name:LAIOSA, SARAH LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LYNN
Last Name:LAIOSA
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 1:77 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1544
Mailing Address - Country:US
Mailing Address - Phone:541-573-3000
Mailing Address - Fax:541-797-6158
Practice Address - Street 1:77 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1544
Practice Address - Country:US
Practice Address - Phone:541-573-3000
Practice Address - Fax:541-797-6158
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO153087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651072Medicaid