Provider Demographics
NPI:1104866193
Name:KOHLER, SUSAN E (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:KOHLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8342
Mailing Address - Country:US
Mailing Address - Phone:541-774-5853
Mailing Address - Fax:541-608-6632
Practice Address - Street 1:2828 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8342
Practice Address - Country:US
Practice Address - Phone:541-774-5853
Practice Address - Fax:541-608-6632
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20125207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082557Medicaid
ORR10545Medicare PIN
ORF29185Medicare UPIN