Provider Demographics
NPI:1700840352
Name:COURTNEY, SUSAN S (MD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:S
Last Name:COURTNEY
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 1:1671 W INA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1910
Mailing Address - Country:US
Mailing Address - Phone:520-797-5555
Mailing Address - Fax:520-575-1566
Practice Address - Street 1:1671 W INA RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1910
Practice Address - Country:US
Practice Address - Phone:520-797-5555
Practice Address - Fax:520-575-1566
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ155202083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1700840352OtherNPI