Basic Information
| Provider Information | |||||||||
| NPI: | 1669716783 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUSAN BAZZELL, MD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 E. BROADWAY | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202885788 | ||||||||
| FaxNumber: | 4809812407 | ||||||||
| Practice Location | |||||||||
| Address1: | 4838 E BASELINE RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812400 | ||||||||
| FaxNumber: | 4809812407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | BAZZELL | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5202885788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 27804 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 531310 | 05 | AZ | MEDICAID |