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General NPI Number Information
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NPI Number | 1477576239
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Entity Type | Individual
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Provider Name | SUSAN E OMURA MD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 25050 SE STARK ST STE 300
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City | GRESHAM
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State | OR
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Zip | 97030-3388
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Country | US
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Telephone | 503-667-8878
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Fax | 503-667-0310
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Provider Business Mailing Address
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Address Line | 3454 NE HASSALO ST
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City | PORTLAND
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State | OR
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Zip | 97232-2527
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Country | US
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Telephone | 503-490-8155
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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 | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | MD23697
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD23697
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License Number State | OR
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