Healthcare Provider Details

I. General information

NPI: 1518088087
Provider Name (Legal Business Name): SUSAN MARIE DURIS ROSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIE DURIS

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S STE 330
FEDERAL WAY WA
98003-8726
US

IV. Provider business mailing address

34503 9TH AVE S STE 330
FEDERAL WAY WA
98003-8726
US

V. Phone/Fax

Practice location:
  • Phone: 253-835-8850
  • Fax: 253-835-8869
Mailing address:
  • Phone: 253-835-8850
  • Fax: 253-835-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60135247
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5756967-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: