Individual
SUSAN TOBEY DENMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18345 SW ALEXANDER ST, SUITE B, ALOHA, OR 97006-3960
(503) 649-9477
(503) 649-1272
Mailing address
4546 SW HUMPHREY BLVD, PORTLAND, OR 97221-2305
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
12671
OR
207ND0900X
Dermatopathology Physician
12671
OR
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
12671
OR
207NP0225X
Pediatric Dermatology Physician
12671
OR
207NS0135X
Procedural Dermatology Physician
12671
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048142000
REGENCE BLUE CROSS BLUE SHIELD OF OREGON
—
01
—
070002027
RAILROAD MEDICARE
—
05
—
260760
—
OR
01
—
38D0621698
CLIA
—
Enumeration date
09/14/2005
Last updated
07/26/2010
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