Basic Information
| Provider Information | |||||||||
| NPI: | 1578608196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUBERT | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235022 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361235022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343966930 | ||||||||
| FaxNumber: | 3343966929 | ||||||||
| Practice Location | |||||||||
| Address1: | 2105 E SOUTH BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361162409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342882100 | ||||||||
| FaxNumber: | 3343966929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 00018653 | AL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.