Provider Demographics
NPI:1154492387
Name:DALBY, SUSAN LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNNE
Last Name:DALBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2380 N FERGUSON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2837
Mailing Address - Country:US
Mailing Address - Phone:520-326-3434
Mailing Address - Fax:520-326-0147
Practice Address - Street 1:2380 N FERGUSON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2837
Practice Address - Country:US
Practice Address - Phone:520-326-3434
Practice Address - Fax:520-326-0147
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ18491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23894Medicare UPIN