Provider Demographics
NPI:1417040387
Name:GUERIN, SUSAN BETH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:GUERIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BETH
Other - Last Name:BARRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11755 SE IDLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6860
Mailing Address - Country:US
Mailing Address - Phone:503-771-8361
Mailing Address - Fax:
Practice Address - Street 1:13705 NE AIRPORT WAY
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1048
Practice Address - Country:US
Practice Address - Phone:503-258-6855
Practice Address - Fax:503-258-6864
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14017207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology