Basic Information
| Provider Information | |||||||||
| NPI: | 1447470893 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUSAN C HUSTAD MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 E 5350 S | ||||||||
| Address2: | STE 335 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844056946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014758600 | ||||||||
| FaxNumber: | 8014758686 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 E 5350 S | ||||||||
| Address2: | STE 335 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844056946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014758600 | ||||||||
| FaxNumber: | 8014758686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | HUSTAD | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8014758600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 377470-1205 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.