Healthcare Provider Details

I. General information

NPI: 1578680435
Provider Name (Legal Business Name): SUZANNE GERALDINE NORTON WURSTLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE GERALDINE NORTON M.D.

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 E MAIN ST
MEDFORD OR
97504-7134
US

IV. Provider business mailing address

PO BOX 1705
MEDFORD OR
97501-0132
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-9720
  • Fax: 541-773-2027
Mailing address:
  • Phone: 541-773-7272
  • Fax: 541-773-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD165458
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA89741
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number249840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: