Provider Demographics
NPI:1427378751
Name:BELCHER, SUSAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:BELCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:GRIFFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4901 MARKET PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8986
Mailing Address - Country:US
Mailing Address - Phone:850-484-4080
Mailing Address - Fax:850-484-8113
Practice Address - Street 1:4901 MARKET PLACE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8986
Practice Address - Country:US
Practice Address - Phone:850-484-4080
Practice Address - Fax:850-484-8113
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1237092081P2900X
390200000X
MN54433208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015502200Medicaid
FL015502200Medicaid
IAENROLLEDMedicaid