Clack, Susan M
Clack, Susan M is an individual health care provider with primary practice located at 13200 Sw Pacific Hwy , Tigard OR 97223. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Clack, Susan M can be contacted via phone (503) 598-2000.Contact Information
Primary practice address
13200 Sw Pacific Hwy
Tigard OR 97223
Phone: (503) 598-2000
Fax: (503) 639-0920
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD14435 | Oregon |
Profile Details
| NPI number | 1669424917 |
|---|---|
| LBN Legal business name | Clack, Susan M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 16th, 2006 |
| Last updated | May 3rd, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669424917 | NPPES |
| Oregon | MEDICAID | 142307 | |
| Oregon | Other | 08118136 |
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