Provider Demographics
NPI:1750358701
Name:HEVERLING, SUSAN E (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:HEVERLING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1200 AIRPORT HEIGHTS DRIVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-277-4440
Mailing Address - Fax:907-277-4430
Practice Address - Street 1:1200 AIRPORT HEIGHTS DRIVE
Practice Address - Street 2:SUITE 305
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-277-4440
Practice Address - Fax:907-277-4430
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2009-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AKAA2807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2807Medicaid
AKMD2807Medicaid
AKF04975Medicare UPIN