Individual
DR. SHIRIN R. SUKUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1200 NW 23RD AVE, LEGACY CLINIC GOOD SAMARITAN, PORTLAND, OR 97210-2906
(503) 413-7074
(503) 413-6769
Mailing address
1200 NW 23RD AVE, LEGACY CLINIC GOOD SAMARITAN, PORTLAND, OR 97210-2906
(503) 413-7074
(503) 413-6769
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD23728
OR
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD23728
OR
Other
Enumeration date
06/03/2006
Last updated
08/27/2007
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