Provider Demographics
NPI:1891905261
Name:TAM SU, ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:TAM SU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:545 NE 47TH AVE
Mailing Address - Street 2:STE. 310
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2238
Mailing Address - Country:US
Mailing Address - Phone:503-636-1310
Mailing Address - Fax:503-636-1310
Practice Address - Street 1:545 NE 47TH AVE
Practice Address - Street 2:STE. 310
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2238
Practice Address - Country:US
Practice Address - Phone:503-238-6233
Practice Address - Fax:503-231-7668
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19238207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy