Provider Demographics
NPI:1245340520
Name:BETZER, SUSAN BEERS (PHD,MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BEERS
Last Name:BETZER
Suffix:
Gender:F
Credentials:PHD,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4818
Mailing Address - Country:US
Mailing Address - Phone:727-823-0402
Mailing Address - Fax:727-823-4153
Practice Address - Street 1:461 7TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4818
Practice Address - Country:US
Practice Address - Phone:727-823-0402
Practice Address - Fax:727-823-4153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME034870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57358Medicare UPIN
FL62235Medicare ID - Type Unspecified