Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD18081 | OR |
N | 208000000X | Pediatrician | MD18081 | OR |
NPI | 1538174057 |
---|---|
Provider Name | Susan Hayflick |
First Address | Portland, OR 97239-2110 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115753 | (05) | OR |
F51634 | (02) |