Basic Information
| Provider Information | |||||||||
| NPI: | 1295850048 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUSAN WAYS PHD MD INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W COOLIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095775005 | ||||||||
| FaxNumber: | 2095211533 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W COOLIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095775005 | ||||||||
| FaxNumber: | 2095211533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 04/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | WAYS | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | CYNTHIA | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2095775005 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | G63946 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.