Provider Demographics
NPI:1043209182
Name:THURMAN, SUSANNAH K (DO)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:K
Last Name:THURMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7368
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7368
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:9201 E MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 137
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5199
Practice Address - Country:US
Practice Address - Phone:480-614-8555
Practice Address - Fax:480-614-8666
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75956OtherVRL
AZ795792OtherAHCCCS
AZ279326Medicare ID - Type Unspecified
AZZ116247Medicare PIN
AZ75956OtherVRL
AZZ133460Medicare PIN