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NPI Code Detail

MEDICARE: SUSAN ELMORE MD

MEDICARE: SUSAN ELMORE MD
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
1103T00000XPsychologistMD19811OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770573354
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN ELMORE MD
Provider Business Mailing Address
First Line : 1776 SW MADISON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1715
Country : US
Telephone Number : 503-231-2641
Fax Number : 503-231-1654
Provider Business Practice Location Address
First Line : 1631 SW COLUMBIA ST
Second Line :
City : PORTLAND
State : OR
Zip : 97201-6025
Country : US
Telephone Number : 503-231-2641
Fax Number : 503-261-1654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 07/08/2007

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Directions to “ SUSAN ELMORE MD” Practice Location

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