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NPI Code Detail

MEDICARE: SUSAN A VICKERMAN DO

MEDICARE: SUSAN A VICKERMAN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician36391CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750383667
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN A VICKERMAN DO
Provider Business Mailing Address
First Line : PO BOX 4330
Second Line :
City : AVON
State : CO
Zip : 81620-4330
Country : US
Telephone Number : 970-926-6340
Fax Number : 970-926-6348
Provider Business Practice Location Address
First Line : 50 BUCK CREEK ROAD
Second Line : SUITE 200
City : AVON
State : CO
Zip : 81620
Country : US
Telephone Number : 970-926-6340
Fax Number : 970-926-6348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 02/21/2017

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Directions to “ SUSAN A VICKERMAN DO” Practice Location

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