Organization
SUZANNE E. ALT, D.O., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE E ALT D.O. (PRESIDENT)
(660) 665-0817
Entity
Organization
Contact information
Practice address
2605 N BALTIMORE ST, KIRKSVILLE, MO 63501-5116
(660) 665-0817
(660) 665-2398
Mailing address
PO BOX 1043, KIRKSVILLE, MO 63501-1043
(913) 248-9693
(913) 248-9383
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MO-R9G62
MO
208VP0000X
Pain Medicine Physician
MO-R9G62
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38463011
BLUE SHIELD KC, MO
—
Enumeration date
03/16/2006
Last updated
02/12/2008
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