MEDICARE: SUSAN HOWARD CULVERHOUSE M.D.

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	207R00000X	Internal Medicine Physician	ME107608	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12145140	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790979813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HOWARD CULVERHOUSE M.D.

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:	904-450-6063
Fax Number	:	904-539-4091

Provider Business Practice Location Address
First Line	:	3801 E HIGHWAY 98
Second Line	:
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-5318
Country	:	US
Telephone Number	:	850-932-3426
Fax Number	:

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	10/03/2024

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