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General NPI Number Information
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NPI Number | 1073745790
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Entity Type | Individual
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Provider Name | SUSAN MCCALL MD
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Gender | Female
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 22260 SW 102ND PL
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City | TUALATIN
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State | OR
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Zip | 97062-7199
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Country | US
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Telephone | 503-330-6627
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Fax |
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Provider Business Mailing Address
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Address Line | 22260 SW 102ND PL
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City | TUALATIN
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State | OR
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Zip | 97062-7199
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Country | US
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Telephone | 503-330-6627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MD19617
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | MD19617
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License Number State | OR
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