Provider Demographics
NPI:1053363564
Name:FRIESEN, SUSAN G (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 E SPRAUGE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2167
Mailing Address - Country:US
Mailing Address - Phone:509-922-2625
Mailing Address - Fax:509-922-4001
Practice Address - Street 1:14402 E SPRAUGE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99216-2167
Practice Address - Country:US
Practice Address - Phone:509-922-2625
Practice Address - Fax:509-922-4001
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8386207Q00000X
WAMD00028856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32539,G000135832Medicare PIN
ID1104070Medicare Oscar/Certification