Individual
SUSAN C HUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
425 E 5350 S, STE 335, OGDEN, UT 84405-6990
(801) 475-8600
(801) 475-8686
Mailing address
425 E 5350 S, STE 335, OGDEN, UT 84405-6990
(801) 475-8600
(801) 475-8686
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
377470-1205
UT
208M00000X
Hospitalist Physician
Primary
377470-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
377470-1205
PHYSICAN & SURGEON LICENS
UT
01
—
377470-8905
STATE CONTROLLED SUBSTANC
UT
Enumeration date
06/21/2005
Last updated
03/07/2023
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