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NPI Code Detail

MEDICARE: DR. SUSAN LEDBETTER D.O.

MEDICARE: DR. SUSAN LEDBETTER 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
1207Q00000XFamily Medicine PhysicianOS9002FL
2207QG0300XGeriatric Medicine (Family Medicine) PhysicianOS9002FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OS 9002OTHERFLSTATE LICENSE NUMBER

General Provider Information

NPI Number : 1780620476
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN LEDBETTER D.O.
Provider Business Mailing Address
First Line : 520 SE 5TH AVE #1113
Second Line :
City : FT. LAUDERDALE
State : FL
Zip : 33301
Country : US
Telephone Number :
Fax Number : 954-262-3753
Provider Business Practice Location Address
First Line : 3200 S UNIVERSITY DR
Second Line :
City : DAVIE
State : FL
Zip : 33328-2018
Country : US
Telephone Number : 954-262-4100
Fax Number : 954-262-3753
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 11/10/2011

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Directions to “ DR. SUSAN LEDBETTER D.O.” Practice Location

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