Provider Demographics
NPI:1629055496
Name:CARY, SUSANNAH REED (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:REED
Last Name:CARY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SUSANNAH
Other - Middle Name:C
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:142 ANTELOPE TRL
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8731
Mailing Address - Country:US
Mailing Address - Phone:719-850-2460
Mailing Address - Fax:
Practice Address - Street 1:103 CHICO CT
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1065
Practice Address - Country:US
Practice Address - Phone:719-852-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167602502Medicaid
TX8U9955OtherBCBS
TX8L12698Medicare PIN
TXI15250Medicare UPIN
TX167602502Medicaid