| Susan C Fair Do Pa | |
|
595 N Courtenay Pkwy Suite 102 Merritt Island FL 32953-4851 | |
| (321) 455-1226 | |
| (321) 456-5531 |
| Full Name | Susan C Fair Do Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 595 N Courtenay Pkwy, Merritt Island, Florida |
| Authorized Official Name and Position | Susan C Fair (PRESIDENT) |
| Authorized Official Contact | 3214551226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan C Fair Do Pa 595 N Courtenay Pkwy Suite 102 Merritt Island FL 32953-4851 Ph: (321) 455-1226 | Susan C Fair Do Pa 595 N Courtenay Pkwy Suite 102 Merritt Island FL 32953-4851 Ph: (321) 455-1226 |
| NPI Number | 1407055874 |
|---|---|
| Provider Enumeration Date | 07/16/2007 |
| Last Update Date | 09/14/2007 |
| Medicare PECOS PAC ID | 4385733385 |
|---|---|
| Medicare Enrollment ID | O20071128000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407055874 | NPI | - | NPPES |
| OS7489 | Other | FL | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS7489 (Florida) | Primary |
| Provider Name | Susan Carole Fair |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457351223 PECOS PAC ID: 7810084985 Enrollment ID: I20071106000661 |
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