Provider Demographics
NPI:1114235025
Name:FRENCH, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:FRENCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:304 COPPER BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:NORDMAN
Mailing Address - State:ID
Mailing Address - Zip Code:83848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 COPPER BAY ROAD
Practice Address - Street 2:
Practice Address - City:NORDMAN
Practice Address - State:ID
Practice Address - Zip Code:83848
Practice Address - Country:US
Practice Address - Phone:208-443-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-63632083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine