Individual
SALLY SUZANNE MARIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1755 COBURG RD STE 5, EUGENE, OR 97401-4982
(541) 654-4175
(541) 844-1291
Mailing address
1755 COBURG RD STE 5, EUGENE, OR 97401-4982
(541) 654-4175
(541) 844-1291
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD14482
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142976
—
OR
Enumeration date
03/01/2006
Last updated
12/06/2011
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