Healthcare Provider Details

I. General information

NPI: 1023261799
Provider Name (Legal Business Name): SUSAN L BRAUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N 16TH ST
PHOENIX AZ
85016-1706
US

IV. Provider business mailing address

4441 E MCDOWELL RD STE 101 SUITE 100
PHOENIX AZ
85008-4503
US

V. Phone/Fax

Practice location:
  • Phone: 602-309-4709
  • Fax: 602-419-2951
Mailing address:
  • Phone: 602-273-6770
  • Fax: 602-267-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: