Provider Demographics
NPI:1427042456
Name:HUGHES, SUSAN Z (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:Z
Last Name:HUGHES
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 1:1000 SE TECH CENTER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5547
Mailing Address - Country:US
Mailing Address - Phone:360-260-2773
Mailing Address - Fax:360-260-2217
Practice Address - Street 1:1000 SE TECH CENTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5547
Practice Address - Country:US
Practice Address - Phone:360-260-2773
Practice Address - Fax:360-260-2217
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8154494Medicaid
1151118301Medicare ID - Type Unspecified
WA8154494Medicaid