Provider Demographics
NPI:1033287685
Name:WAYS, SUSAN C (PHD MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:WAYS
Suffix:
Gender:F
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-577-5005
Mailing Address - Fax:209-521-1533
Practice Address - Street 1:200 W COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-577-5005
Practice Address - Fax:209-521-1533
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG063946207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology