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General NPI Number Information
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NPI Number | 1477506053
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Entity Type | Individual
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Provider Name | SUZANNA DYANN HUBELE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 683 E 3RD ST
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City | WEISER
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State | ID
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Zip | 83672-2248
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Country | US
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Telephone | 208-549-0211
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Fax | 208-549-0104
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Provider Business Mailing Address
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Address Line | PO BOX 871
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City | WEISER
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State | ID
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Zip | 83672-0871
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Country | US
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Telephone | 208-549-0211
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Fax | 208-549-0104
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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 | M-9419
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License Number State | ID
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