Provider Demographics
NPI:1992190292
Name:SAMUEL SUK, MD, PC
Entity Type:Organization
Organization Name:SAMUEL SUK, MD, PC
Other - Org Name:SAMUEL SUK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-298-3728
Mailing Address - Street 1:1500 NW BETHANY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5208
Mailing Address - Country:US
Mailing Address - Phone:503-298-3728
Mailing Address - Fax:
Practice Address - Street 1:1500 NW BETHANY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5236
Practice Address - Country:US
Practice Address - Phone:503-298-3728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21879207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500692661Medicaid