Provider Demographics
NPI:1710910666
Name:BRICELAND, SUSAN ANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:BRICELAND
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 1:13624 W CAMINO DEL SOL STE 200
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-3401
Mailing Address - Country:US
Mailing Address - Phone:623-546-6599
Mailing Address - Fax:623-546-2399
Practice Address - Street 1:13624 W CAMINO DEL SOL STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-3401
Practice Address - Country:US
Practice Address - Phone:623-546-6599
Practice Address - Fax:623-546-2399
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19009207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72180Medicare ID - Type Unspecified
AZF56062Medicare UPIN