Provider Demographics
NPI:1780676908
Name:WESTPHAL, SUZANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:L
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 MARINSHIP WAY STE 370
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2853
Mailing Address - Country:US
Mailing Address - Phone:415-887-9758
Mailing Address - Fax:415-887-9763
Practice Address - Street 1:2330 MARINSHIP WAY STE 370
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2853
Practice Address - Country:US
Practice Address - Phone:415-887-9758
Practice Address - Fax:415-887-9763
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-083365207N00000X
CAG89217207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL61233Medicare ID - Type Unspecified
ILF73168Medicare UPIN