Individual
DR. SUSAN ELISE KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9750
(503) 653-6440
(503) 571-8974
Mailing address
20200 SE WALGREN RD, DAMASCUS, OR 97089
(503) 658-7218
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MD00037941
WA
207N00000X
Dermatology Physician
Primary
MD21378
OR
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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