Provider Demographics
NPI:1225026107
Name:MOISON, SUSAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:MOISON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-322-2240
Mailing Address - Fax:303-322-9260
Practice Address - Street 1:2055 N HIGH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-322-2240
Practice Address - Fax:303-322-9260
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-02-01
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Provider Licenses
StateLicense IDTaxonomies
CO26907207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY135598800Medicaid
CO01269075Medicaid
CO811072Medicare PIN
COCO306175Medicare PIN
COCOA108857Medicare PIN
COL3034Medicare PIN
COD24866Medicare UPIN
CO01269075Medicaid