Organization
JOEL M SUCKOW-MD, LLC
Active
Organization
JOEL M SUCKOW-MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY GONZALEZ (CREDENTIALING MANAGER)
(541) 941-7792
Entity
Organization
Contact information
Practice address
773 LINDA AVE NE, KEIZER, OR 97303-4549
(971) 808-2854
(888) 256-7959
Mailing address
773 LINDA AVE NE, KEIZER, OR 97303-4549
(503) 585-7454
(888) 256-7959
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OR MD28195
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OR MD28195
OREGON STATE LICNESE
OR
Enumeration date
09/21/2016
Last updated
03/07/2023
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