Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 2014 | OR |
Y | 213ER0200X | Radiology | 2014 | OR |
NPI | 1679529200 |
---|---|
Provider Name | Dr. Susan Marie Yazvac |
First Address | Portland, OR 97206-3211 |
Second Address | Portland, OR 97206-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U30867 | (02) | OR |