Provider Demographics
NPI:1255346029
Name:SUDAKIN, DANIEL L (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:SUDAKIN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9370 SW GREENBURG RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-894-9258
Mailing Address - Fax:888-307-3066
Practice Address - Street 1:9370 SW GREENBURG RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-894-9258
Practice Address - Fax:888-307-3066
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD199942083T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH95660Medicare UPIN
ORH95660Medicare UPIN