Provider Demographics
NPI:1083609697
Name:PAUTLER, SUZANNE M (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:PAUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 COUCH AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5536
Mailing Address - Country:US
Mailing Address - Phone:573-636-3483
Mailing Address - Fax:573-636-5315
Practice Address - Street 1:1445 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2853
Practice Address - Country:US
Practice Address - Phone:573-636-3483
Practice Address - Fax:573-636-5315
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K42207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00387102OtherRR MEDICARE
MO203681523Medicaid
MOP00387102OtherRR MEDICARE