Provider Demographics
NPI:1780709642
Name:LAN, SUSAN C (DO, MPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:LAN
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4531
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-4531
Mailing Address - Country:US
Mailing Address - Phone:970-306-1448
Mailing Address - Fax:970-926-0560
Practice Address - Street 1:4721 BELLYACHE RIDGE RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CO
Practice Address - Zip Code:81655
Practice Address - Country:US
Practice Address - Phone:970-306-1448
Practice Address - Fax:970-926-0560
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO446072083P0901X
FLOS93302083P0901X
TXL13642083P0901X
CA20A111032083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine