Individual
DR. MARY SUSAN ZICKEFOOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
571 TAYLOR TRL, CANON CITY, CO 81212-3600
(719) 275-6200
Mailing address
571 TAYLOR TRL, CANON CITY, CO 81212-3600
(719) 275-6200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41337
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97958557
—
CO
Enumeration date
02/19/2007
Last updated
09/05/2013
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