Provider Demographics
NPI:1871674374
Name:SUZANNE CLELAND ZAMUDIO MD PC
Entity Type:Organization
Organization Name:SUZANNE CLELAND ZAMUDIO MD PC
Other - Org Name:PORTLAND EAR NOSE AND THROAT SPECIALISTS PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLELAND-ZAMUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-408-1323
Mailing Address - Street 1:PO BOX 23200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3200
Mailing Address - Country:US
Mailing Address - Phone:503-408-1323
Mailing Address - Fax:503-408-4463
Practice Address - Street 1:501 N. GRAHAM
Practice Address - Street 2:#455
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-408-1323
Practice Address - Fax:503-408-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR104862Medicare PIN