Provider Demographics
NPI:1417110487
Name:SCOTT, SUSAN DUFFY (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DUFFY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:JILL
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:24640 JEFFERSON AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9027
Mailing Address - Country:US
Mailing Address - Phone:951-677-1323
Mailing Address - Fax:
Practice Address - Street 1:24640 JEFFERSON AVE STE 109
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9027
Practice Address - Country:US
Practice Address - Phone:951-677-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0674213ES0103X
CAE4783213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery