1114927118 NPI number — SUSAN GARZA ANDERSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114927118 NPI number — SUSAN GARZA ANDERSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ANDERSON

Provider First Name:

SUSAN

Provider Middle Name:

GARZA

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

ANDERSON

Provider Other First Name:

SUSAN MARIE

Provider Other Middle Name:

GARZA

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

2

NPI Number:

1114927118

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/04/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1311 WESTMONT CT

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SOUTHLAKE

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

76092-7814

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

214-458-1483

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1311 WESTMONT CT

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SOUTHLAKE

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

76092-7814

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

214-458-1483

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/01/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  K6461 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 131144109 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144113 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144118 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144112 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144114 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144121 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144116 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144122 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144120 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144110 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144115 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131144119 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 179236801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8A0122 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".