Basic Information
| Provider Information | |||||||||
| NPI: | 1972692028 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VEST | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2051 EVERGREEN LN D | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285372200 | ||||||||
| FaxNumber: | 9285372204 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 WEST HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | WHITERIVER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859410860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283384911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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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 | 207R00000X | 35860 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0097-01183 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 35860 | AZ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 0097-01183 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1295993376 | 05 | AZ | MEDICAID | 1871523191 | 05 | AZ | MEDICAID | 541947 | 05 | AZ | MEDICAID | 1780614008 | 05 | AZ | MEDICAID | 1629236716 | 05 | AZ | MEDICAID |