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NPI Code Detail

MEDICARE: DR. SUZANNE HEIDI SAMPLE STAUDINGER MD

MEDICARE: DR. SUZANNE HEIDI SAMPLE STAUDINGER MD
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
1207QG0300XGeriatric Medicine (Family Medicine) PhysicianMD00020811WA

General Provider Information

NPI Number : 1861572737
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUZANNE HEIDI SAMPLE STAUDINGER MD
Provider Business Mailing Address
First Line : 723 MEMORIAL ST
Second Line :
City : PROSSER
State : WA
Zip : 99350-1524
Country : US
Telephone Number : 509-786-2222
Fax Number : 509-786-6612
Provider Business Practice Location Address
First Line : 701 DALE AVE
Second Line :
City : BENTON CITY
State : WA
Zip : 99320-5250
Country : US
Telephone Number : 509-588-4077
Fax Number : 509-588-4197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 06/02/2021

Similar Medicare Providers

1437199072 — PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Practice Location Address:
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1639111586 — MIGUEL L. MEDRANO P.A.
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1679658777 — MS. TONI DIANE MICROULIS ARNP
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1619224896 — MICHELLE MARIE PEHRSON FNP-C
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1669811139 — DR. MICHAEL HENRY ADLING D.O.
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