Healthcare Provider Details

I. General information

NPI: 1033287685
Provider Name (Legal Business Name): SUSAN C WAYS PHD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W COOLIDGE AVE
MODESTO CA
95350
US

IV. Provider business mailing address

200 W COOLIDGE AVE
MODESTO CA
95350
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-5005
  • Fax: 209-521-1533
Mailing address:
  • Phone: 209-577-5005
  • Fax: 209-521-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG063946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: