Individual
AMBROSE K SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2408 NE DIVISION ST, BEND, OR 97701-3543
(541) 388-2861
(541) 382-6297
Mailing address
2408 NE DIVISION ST, BEND, OR 97701-3543
(541) 388-2861
(541) 382-6297
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
DP00159
OR
213E00000X
Podiatrist
DPOO159
OR
213ES0000X
Sports Medicine Podiatrist
DP00159
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
DP00159
OR
213ES0131X
Foot Surgery Podiatrist
Primary
DP00159
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024734001
BLUE CROSS
OR
01
—
13578
CLEAR CHOICE HEALTH PLANS
OR
05
—
214619
—
OR
01
—
480031260
RR MEDICARE
OR
Enumeration date
12/14/2005
Last updated
01/16/2013
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