Provider Demographics
NPI:1588670582
Name:SANDERS, SUSAN F (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:SANDERS
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 1:3649 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4030
Mailing Address - Country:US
Mailing Address - Phone:970-375-1707
Mailing Address - Fax:970-382-9518
Practice Address - Street 1:3649 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4030
Practice Address - Country:US
Practice Address - Phone:970-375-1707
Practice Address - Fax:970-382-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28524207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO070007721OtherMEDICARE RAILROAD
CO20898OtherLOVELACE
CO841281385001OtherROCKY MOUNTAIN HMO
CO841281385/02OtherPACIFICARE
COSA79901OtherBC/BS
CO20898OtherLOVELACE
CO841281385/02OtherPACIFICARE