Provider Demographics
NPI:1457356040
Name:FUZZARD, SUSAN C (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:FUZZARD
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:PO BOX 8090
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011-8090
Mailing Address - Country:US
Mailing Address - Phone:504-454-4133
Mailing Address - Fax:504-456-8125
Practice Address - Street 1:4200 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:504-455-4133
Practice Address - Fax:504-456-8125
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14233R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1101770Medicaid
LA4A660Medicare PIN
LA1101770Medicaid