Individual
SUSAN A BLASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
17550 PROVOST ST STE 201, LAKE OSWEGO, OR 97034-5199
(503) 513-3350
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO200035
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2016
Last updated
01/29/2021
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