Healthcare Provider Details

I. General information

NPI: 1619924735
Provider Name (Legal Business Name): SUSAN ELIZABETH CRUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ERIE PKWY STE 201E
ERIE CO
80516-4072
US

IV. Provider business mailing address

5450 WESTERN AVE SUITE B
BOULDER CO
80301-2709
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-8820
  • Fax: 303-938-3499
Mailing address:
  • Phone: 303-415-8820
  • Fax: 303-938-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45815
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: