Healthcare Provider Details

I. General information

NPI: 1245327949
Provider Name (Legal Business Name): SUSAN K AILOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BUSINESS LOOP 70 W
COLUMBIA MO
65201
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65202
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8445
  • Fax: 573-884-4134
Mailing address:
  • Phone: 573-882-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR2K92
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: