MEDICARE: SUSAN B. FLEMING, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician

General Provider Information

NPI Number	:	1134283500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN B. FLEMING, M.D., P.C.

Provider Business Mailing Address
First Line	:	4725 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5610
Country	:	US
Telephone Number	:	520-888-2424
Fax Number	:	520-888-8493

Provider Business Practice Location Address
First Line	:	4725 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5610
Country	:	US
Telephone Number	:	520-888-2424
Fax Number	:	520-888-8493

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUSAN B FLEMING
Credential	:	M.D.
Telephone Number	:	520-888-2427

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/15/2010

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