Provider Demographics
NPI:1609147933
Name:SZUCS, PETER J (MAW, LMT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:SZUCS
Suffix:
Gender:M
Credentials:MAW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 NE TILLAMOOK ST
Mailing Address - Street 2:APARTMENT #183
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 NE 132ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-3014
Practice Address - Country:US
Practice Address - Phone:503-251-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator