Healthcare Provider Details

I. General information

NPI: 1154492387
Provider Name (Legal Business Name): SUSAN LYNNE DALBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N FERGUSON AVE SUITE 102
TUCSON AZ
85712-2837
US

IV. Provider business mailing address

2380 N FERGUSON AVE SUITE 102
TUCSON AZ
85712-2837
US

V. Phone/Fax

Practice location:
  • Phone: 520-326-3434
  • Fax: 520-326-0147
Mailing address:
  • Phone: 520-326-3434
  • Fax: 520-326-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: