Provider Demographics
NPI:1093743247
Name:MIDDLETON, SUSAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:400 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2745
Mailing Address - Country:US
Mailing Address - Phone:719-584-4767
Mailing Address - Fax:719-595-7906
Practice Address - Street 1:56 CLUB MANOR DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1679
Practice Address - Country:US
Practice Address - Phone:719-584-4767
Practice Address - Fax:719-595-7906
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO284612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E50780Medicare UPIN