Provider Demographics
NPI:1427347889
Name:BERTRAM, SUZANNE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LYNN
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST #E101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1872
Mailing Address - Country:US
Mailing Address - Phone:970-493-5334
Mailing Address - Fax:970-494-2008
Practice Address - Street 1:2001 S SHIELDS ST #E101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1872
Practice Address - Country:US
Practice Address - Phone:970-493-5334
Practice Address - Fax:970-494-2008
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30896207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology