Provider Demographics
NPI:1538142609
Name:MCCONNAUGHEY, SUZANNE F (DO)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:F
Last Name:MCCONNAUGHEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:F
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1512 12TH AVE RD
Mailing Address - Street 2:APOGEE PHYSICIANS
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6008
Mailing Address - Country:US
Mailing Address - Phone:208-463-5164
Mailing Address - Fax:208-463-5172
Practice Address - Street 1:1512 12TH AVE RD
Practice Address - Street 2:APOGEE PHYSICIANS
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6008
Practice Address - Country:US
Practice Address - Phone:208-463-5164
Practice Address - Fax:208-463-5172
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0545208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010133599Medicaid
TN3000863Medicare PIN
VA006704C23Medicare ID - Type Unspecified
VA010133599Medicaid