Individual
SUSAN WHITMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14506 W GRANITE VALLEY DR, #124, SUN CITY WEST, AZ 85375-6010
(623) 584-2127
(623) 584-1257
Mailing address
13943 N 91ST AVE, C-101, PEORIA, AZ 85381-3629
(623) 760-9449
(623) 974-9351
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
43436
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1458299
UNITED HEALTHCARE
AZ
01
—
1508893975
BLUE CROSS BLUE SHIELD
AZ
05
—
285731600
—
MD
01
—
5496138
AETNA
AZ
01
—
618847
AHCCCS
AZ
05
—
618847
—
AZ
01
—
757814
ARIZONA MEDICAL NETWORK
AZ
01
—
P00942249
RAILROAD MEDICARE
AZ
Enumeration date
06/28/2006
Last updated
01/26/2016
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