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General NPI Number Information
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NPI Number | 1356485767
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Entity Type | Individual
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Provider Name | ELIZABETH HART SUGDEN MD
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Gender | Female
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 132 5TH AVE W
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City | JEROME
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State | ID
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Zip | 83338-1825
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Country | US
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Telephone | 208-324-5286
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Fax | 208-324-9815
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Provider Business Mailing Address
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Address Line | PO BOX 587
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City | TWIN FALLS
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State | ID
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Zip | 83303-0587
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Country | US
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Telephone | 208-814-7400
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Fax | 208-814-7491
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M5431
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License Number State | ID
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