| Joel M Suckow-md, Llc | |
|
773 Linda Ave Ne Keizer OR 97303-4549 | |
| (971) 808-2854 | |
| (888) 256-7959 |
| Full Name | Joel M Suckow-md, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 773 Linda Ave Ne, Keizer, Oregon |
| Authorized Official Name and Position | Tracy Gonzalez (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5419417792 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Joel M Suckow-md, Llc 773 Linda Ave Ne Keizer OR 97303-4549 Ph: (503) 585-7454 | Joel M Suckow-md, Llc 773 Linda Ave Ne Keizer OR 97303-4549 Ph: (971) 808-2854 |
| NPI Number | 1700335536 |
|---|---|
| Provider Enumeration Date | 09/21/2016 |
| Last Update Date | 03/07/2023 |
| Certification Date | 12/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700335536 | NPI | - | NPPES |
| OR MD28195 | Other | OR | OREGON STATE LICNESE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | OR MD28195 (Oregon) | Primary |
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