Provider Demographics
NPI:1639333727
Name:SUCKOW, JOEL M (MD)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:M
Last Name:SUCKOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 LINDA AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4549
Mailing Address - Country:US
Mailing Address - Phone:971-808-2854
Mailing Address - Fax:888-256-7959
Practice Address - Street 1:773 LINDA AVE NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:971-808-2854
Practice Address - Fax:888-256-7959
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD281952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry