Provider Demographics
NPI:1497840383
Name:BELZER, SUZANNE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LYNN
Last Name:BELZER
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:P.O. BOX 31001-0698
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0698
Mailing Address - Country:US
Mailing Address - Phone:602-263-1511
Mailing Address - Fax:602-263-1637
Practice Address - Street 1:4212 N. 16TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-200-5975
Practice Address - Fax:602-200-5375
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23184207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ695116Medicaid
AZ0892620OtherBCBS
PART A:030078Medicare ID - Type Unspecified
PART B: 8HZH46Medicare ID - Type Unspecified
AZ695116Medicaid