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NPI Code Detail

MEDICARE: DR. MARY SUSANNE PLACEK M.D.

MEDICARE: DR. MARY SUSANNE PLACEK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMR-1208ID
2207Q00000XFamily Medicine PhysicianMD167924OR

General Provider Information

NPI Number : 1265727515
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY SUSANNE PLACEK M.D.
Provider Business Mailing Address
First Line : PO BOX 309
Second Line :
City : INDEPENDENCE
State : OR
Zip : 97351-0309
Country : US
Telephone Number : 503-838-1133
Fax Number : 503-838-5138
Provider Business Practice Location Address
First Line : 1430 MONMOUTH ST
Second Line :
City : INDEPENDENCE
State : OR
Zip : 97351-1127
Country : US
Telephone Number : 503-838-1133
Fax Number : 503-838-5138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2011
Last Update Date : 09/04/2014

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