Provider Demographics
NPI:1245443100
Name:NUSSER, DANIEL L (DPM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:NUSSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 NE BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-284-1244
Mailing Address - Fax:503-288-3535
Practice Address - Street 1:2809 NE BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-284-1244
Practice Address - Fax:503-288-3535
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00215213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U05995Medicare UPIN
ORROOOOSGBKKMedicare PIN