Su, Ambrose K
Su, Ambrose K is an individual health care provider with primary practice located at 2408 Ne Division St , Bend OR 97701-3543. He recently has 4 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Sports Medicine, Podiatric Medicine & Surgery Service Providers / Foot Surgery, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Foot Surgery is his primary health care specialty. Su, Ambrose K can be contacted via phone (541) 388-2861.Contact Information
Primary practice address
2408 Ne Division St
Bend OR 97701-3543
Phone: (541) 388-2861
Fax: (541) 382-6297
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | DPOO159 | Oregon |
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | DP00159 | Oregon |
| Podiatric Medicine & Surgery Service Providers / Sports Medicine | 213ES0000X | DP00159 | Oregon |
| Podiatric Medicine & Surgery Service Providers / Foot Surgery | 213ES0131X | DP00159 | Oregon |
| Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery | 213ES0103X | DP00159 | Oregon |
Profile Details
| NPI number | 1588649297 |
|---|---|
| LBN Legal business name | Su, Ambrose K |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 14th, 2005 |
| Last updated | Jan 16th, 2013 - about 11 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 | 1588649297 | NPPES |
| Oregon | Other | 024734001 | BLUE CROSS |
| Oregon | Other | 480031260 | BLUE CROSS |
| Oregon | Other | 13578 | BLUE CROSS |
| Oregon | MEDICAID | 214619 | BLUE CROSS |
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