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General NPI Number Information
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NPI Number | 1568431013
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Entity Type | Organization
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Legal Business Name | SUZANNE E. ALT, D.O., LLC
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 2605 N BALTIMORE ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-5116
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Country | US
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Telephone | 660-665-0817
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Fax | 660-665-2398
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Provider Business Mailing Address
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Address Line | PO BOX 1043
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City | KIRKSVILLE
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State | MO
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Zip | 63501-1043
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Country | US
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Telephone | 913-248-9693
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Fax | 913-248-9383
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUZANNE E ALT
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Credential | D.O.
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Telephone | 660-665-0817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | MO-R9G62
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MO-R9G62
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License Number State | MO
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