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Individual
SUSAN M DOUGLAS
Active
Individual
SUSAN M DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01052790A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000207857
BCBS PIN
IN
01
—
000000501000
BCBS - DEACONESS GATEWAY
IN
01
—
000001146552
ANTHEM PROVIDER NUMBER
IN
05
—
300010735
—
IN
05
—
64041742
—
KY
Enumeration date
06/28/2006
Last updated
01/25/2021
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