Healthcare Provider Details

I. General information

NPI: 1386861235
Provider Name (Legal Business Name): SUZAN SAM BUXTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 W THUNDERBIRD BLVD STE C100
SUN CITY AZ
85351-3097
US

IV. Provider business mailing address

6622 N 91ST AVE STE 220
GLENDALE AZ
85305-2569
US

V. Phone/Fax

Practice location:
  • Phone: 623-974-1763
  • Fax: 623-972-2038
Mailing address:
  • Phone: 602-759-6883
  • Fax: 602-224-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP18466
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: