MEDICARE: SUSAN M MCMASTER D O

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	207Q00000X	Family Medicine Physician	29909	CO
2	207Q00000X	Family Medicine Physician	632	HI
3	207Q00000X	Family Medicine Physician	05-23055	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154322733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M MCMASTER D O

Provider Business Mailing Address
First Line	:	PO BOX 490
Second Line	:
City	:	CASCADE
State	:	CO
Zip	:	80809-0490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 ARBOR WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-2128
Country	:	US
Telephone Number	:	719-471-6512
Fax Number	:	719-572-9033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/17/2009

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Directions to “ SUSAN M MCMASTER D O” Practice Location

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