Provider Demographics
NPI:1629227095
Name:SAUSER, MARK JASON (LCPO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JASON
Last Name:SAUSER
Suffix:
Gender:M
Credentials:LCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 NE 102ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4169
Mailing Address - Country:US
Mailing Address - Phone:503-252-5100
Mailing Address - Fax:503-253-8086
Practice Address - Street 1:173 NE 102ND AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4169
Practice Address - Country:US
Practice Address - Phone:503-252-5100
Practice Address - Fax:503-253-8086
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DECO004701OtherAMERICAN BOARD FOR CERTIFICATION ORTHTOICS & PROSTHETIC
OR22962Medicaid
OR22962Medicaid