Individual
SUSANNE K BOBENRIETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17727 E BURNSIDE ST, PORTLAND, OR 97233-4803
(503) 215-9800
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD23038
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0155143
L.&I.
WA
05
—
287472
—
OR
Enumeration date
12/02/2005
Last updated
03/07/2025
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