Provider Demographics
NPI:1316477797
Name:DUNHAM, SARA ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ALEXANDRA
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:SUBLIMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97385-0886
Mailing Address - Country:US
Mailing Address - Phone:503-769-2259
Mailing Address - Fax:503-769-8049
Practice Address - Street 1:114 SE CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUBLIMITY
Practice Address - State:OR
Practice Address - Zip Code:97385-9714
Practice Address - Country:US
Practice Address - Phone:503-769-2259
Practice Address - Fax:503-769-8049
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD200221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine