Individual
ELIZABETH HART SUGDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
132 5TH AVE W, JEROME, ID 83338-1825
(208) 324-5286
(208) 324-9815
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5431
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001456
BLUE SHIELD OF IDAHO
ID
01
—
000010142921
BLUE SHIELD OF IDAHO
ID
05
—
003943200
—
ID
01
—
080064467
MEDICARE RAILROAD
ID
01
—
1120618
STATE INSURANCE FUND
ID
01
—
54312
BLUE CROSS OF IDAHO
ID
01
—
820227163B002
TRICARE
ID
01
—
820227163G013
TRICARE
ID
01
—
J8499
BLUE CROSS OF IDAHO
ID
Enumeration date
02/18/2007
Last updated
01/08/2015
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