Provider Demographics
NPI:1659355311
Name:COLLIER, SUSANNAH L (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:L
Last Name:COLLIER
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 1:3030 NW 149TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1849
Mailing Address - Country:US
Mailing Address - Phone:405-562-8850
Mailing Address - Fax:405-562-6550
Practice Address - Street 1:3030 NW 149TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1849
Practice Address - Country:US
Practice Address - Phone:405-562-8850
Practice Address - Fax:405-562-6550
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002030861207N00000X, 207NP0225X, 207NS0135X
OK24822207N00000X, 207NP0225X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH87910Medicare UPIN
OKOKB5208Medicare UPIN
MO903843092Medicare ID - Type UnspecifiedMEDICARE NUMBER - LDSC