Individual
SUSAN K ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
(918) 453-1234
(918) 453-9107
Mailing address
PO BOX 500, TAHLEQUAH MEDICAL GROUP, TAHLEQUAH, OK 74465-0500
(918) 456-0641
(918) 453-2341
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
057769
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04BDCRW
MEDICARE
GA
05
—
200317560A
—
OK
05
—
454914001A
—
GA
05
—
454914001B
—
GA
05
—
G57769
—
SC
Enumeration date
05/11/2006
Last updated
05/20/2016
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