Provider Demographics
NPI:1730241464
Name:GLOYD, SUSAN VITALI (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VITALI
Last Name:GLOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8308 ANAHEIM AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2853
Mailing Address - Country:US
Mailing Address - Phone:505-858-0413
Mailing Address - Fax:505-858-0413
Practice Address - Street 1:8308 ANAHEIM AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2853
Practice Address - Country:US
Practice Address - Phone:505-858-0413
Practice Address - Fax:505-858-0413
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM95-245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine