Provider Demographics
NPI:1275534166
Name:EFFERTZ, SUSAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:EFFERTZ
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 1:6 BEAR PAW PL
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6438
Mailing Address - Country:US
Mailing Address - Phone:406-727-2442
Mailing Address - Fax:
Practice Address - Street 1:3687 VETERANS DRIVE
Practice Address - Street 2:FORT HARRISON
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59636-1500
Practice Address - Country:US
Practice Address - Phone:877-468-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4673208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0065078Medicaid
C64151Medicare UPIN
MT0065078Medicaid