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General NPI Number Information
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NPI Number | 1538174057
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Entity Type | Individual
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Provider Name | SUSAN HAYFLICK MD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD ATTN: GLENDA BENTON, L103A
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-5516
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK ROAD ATTENTION: GLENDA BENTON, L103A
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City | PORTLAND
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State | OR
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Zip | 97239-2110
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Country | US
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Telephone |
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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 | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | MD18081
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207SG0202X
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Taxonomy Name | Clinical Biochemical Genetics Physician
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License Number | 18081
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number | 18081
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD18081
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License Number State | OR
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