Provider Demographics
NPI:1760649974
Name:SULTZ, SARA EMSLIE (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:EMSLIE
Last Name:SULTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:EMSLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-831-2100
Mailing Address - Fax:254-831-2101
Practice Address - Street 1:1009 ARBOR PARK
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-8196
Practice Address - Country:US
Practice Address - Phone:254-831-2100
Practice Address - Fax:254-831-2101
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26246208000000X
TXP9467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3438319-01Medicaid