Provider Demographics
NPI:1407820814
Name:PARDEE, SUSAN RUTLEDGE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RUTLEDGE
Last Name:PARDEE
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 1:312 N ALMA SCHOOL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4354
Mailing Address - Country:US
Mailing Address - Phone:480-948-8400
Mailing Address - Fax:480-948-8401
Practice Address - Street 1:312 N ALMA SCHOOL RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4354
Practice Address - Country:US
Practice Address - Phone:480-948-8400
Practice Address - Fax:480-948-8401
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15086207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD37413Medicare UPIN
AZD37413Medicare UPIN