Basic Information
Provider Information
NPI: 1477500064
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEYER
FirstName: SUSAN
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 34936
Address2: DEPT # 5006
City: SEATTLE
State: WA
PostalCode: 981241936
CountryCode: US
TelephoneNumber: 2064392988
FaxNumber: 2064313939
Practice Location
Address1: 16233 SYLVESTER RD SW
Address2: SUITE G40
City: BURIEN
State: WA
PostalCode: 981663045
CountryCode: US
TelephoneNumber: 2062446625
FaxNumber: 2062446726
Other Information
ProviderEnumerationDate: 05/28/2006
LastUpdateDate: 09/19/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD00036750WAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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