Individual
SUSAN L ELIZONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
359-A WEST HIGHWAY 264, ST MICHAELS, AZ 86511-0370
(928) 810-3800
(928) 810-3801
Mailing address
PO BOX 370, 359-A WEST HIGHWAY 264, ST MICHAELS, AZ 86511-0370
(928) 810-3800
(928) 810-3801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
227968
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156365
—
AZ
01
—
Z135040
MEDICARE PTAN
—
Enumeration date
05/27/2006
Last updated
09/17/2012
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