Healthcare Provider Details

I. General information

NPI: 1023066131
Provider Name (Legal Business Name): SUSAN M. STEPHENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N 5TH AVE PAPPAS MEDICAL CLINIC
PHOENIX AZ
85003-1507
US

IV. Provider business mailing address

1551 W LEWIS AVE
PHOENIX AZ
85007-1205
US

V. Phone/Fax

Practice location:
  • Phone: 602-452-4753
  • Fax: 602-452-4789
Mailing address:
  • Phone: 602-252-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17106
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: