Provider Demographics
NPI:1578680435
Name:WURSTLE, SUZANNE GERALDINE NORTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:GERALDINE NORTON
Last Name:WURSTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:GERALDINE
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0132
Mailing Address - Country:US
Mailing Address - Phone:541-773-7272
Mailing Address - Fax:541-773-2027
Practice Address - Street 1:842 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7134
Practice Address - Country:US
Practice Address - Phone:541-773-9720
Practice Address - Fax:541-773-2027
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD165458207L00000X
CAA89741207L00000X
NY249840207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology