Provider Demographics
NPI:1033111547
Name:THOMPSON, SUSANNE PATRICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:PATRICIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27434
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74149-0434
Mailing Address - Country:US
Mailing Address - Phone:918-587-5100
Mailing Address - Fax:918-587-5102
Practice Address - Street 1:2526 W EDISON ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-587-5100
Practice Address - Fax:918-587-5102
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100092790CMedicaid
OK100092790CMedicaid