Provider Demographics
NPI:1700806510
Name:DANIELS, SUSAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:280 W KAGY BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6056
Mailing Address - Country:US
Mailing Address - Phone:406-522-5437
Mailing Address - Fax:406-522-1536
Practice Address - Street 1:280 W KAGY BLVD
Practice Address - Street 2:STE G
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6056
Practice Address - Country:US
Practice Address - Phone:406-522-5437
Practice Address - Fax:406-522-1536
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT11251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN343698500Medicaid
MN343698500Medicaid