Individual
SUSAN M CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13200 SW PACIFIC HWY, TIGARD, OR 97223
(503) 598-2000
(503) 639-0920
Mailing address
13200 SW PACIFIC HWY, TIGARD, OR 97223-4828
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD14435
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08118136
RR PIN
—
05
—
142307
—
OR
Enumeration date
05/16/2006
Last updated
05/03/2013
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