Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 45805 | CO |
N | 2086S0120X | Pediatric Surgery | A69017 | CA |
NPI | 1083836589 |
---|---|
Provider Name | Suzanne Yoder |
First Address | Santa Maria, AR 93454 |
Second Address | Denver, CO 80205-5504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025570000 | (05) | NE |
1083836589 | (05) | MT |
1083836589 | (05) | WI |
1083836589 | (05) | WY |
69972770 | (05) | CO |
7721930 | (05) | SD |