1598762429 NPI number — DR. SUZANNE M. DAVIS MD

Table of content: DR. SUZANNE M. DAVIS MD (NPI 1598762429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598762429 NPI number — DR. SUZANNE M. DAVIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
SUZANNE
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUGOPOLSKI
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598762429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-569-9904
Provider Business Mailing Address Fax Number:
972-569-9943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5333 WEST UNIVERSITY DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-569-9904
Provider Business Practice Location Address Fax Number:
972-569-9943
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  K2007 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 126629805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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