Provider Demographics
NPI:1316973613
Name:OSS, SUZANNE E K (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E K
Last Name:OSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:E
Other - Last Name:KNEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:916 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2708
Mailing Address - Country:US
Mailing Address - Phone:307-675-5555
Mailing Address - Fax:307-675-5599
Practice Address - Street 1:916 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2708
Practice Address - Country:US
Practice Address - Phone:307-675-5555
Practice Address - Fax:307-675-5599
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7342A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313979OtherBLUE CROSS
WY122101900Medicaid