Individual
SALLY J WENTROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9701 SW BARNES RD, SUITE 200, PORTLAND, OR 97225-6772
(503) 734-3700
(503) 473-8462
Mailing address
7650 SW BEVELAND RD, SUITE 200, PORTLAND, OR 97223-8692
(503) 734-3700
(503) 473-8462
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD17318
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049283
—
OR
01
—
R108981
MEDICARE PTAN
OR
Enumeration date
11/16/2005
Last updated
06/24/2016
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