Healthcare Provider Details

I. General information

NPI: 1275534166
Provider Name (Legal Business Name): SUSAN J EFFERTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERANS DRIVE FORT HARRISON
HELENA MT
59636-1500
US

IV. Provider business mailing address

6 BEAR PAW PL
GREAT FALLS MT
59404-6438
US

V. Phone/Fax

Practice location:
  • Phone: 877-468-8387
  • Fax:
Mailing address:
  • Phone: 406-727-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4673
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: