Provider Demographics
NPI:1033178751
Name:BRISTER, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:BRISTER
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 1:2700 PECAN ST W
Mailing Address - Street 2:STE 102
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3199
Mailing Address - Country:US
Mailing Address - Phone:512-421-3750
Mailing Address - Fax:512-421-3751
Practice Address - Street 1:2700 PECAN ST W
Practice Address - Street 2:STE 102
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3199
Practice Address - Country:US
Practice Address - Phone:512-421-3750
Practice Address - Fax:512-421-3751
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314182YLPSOtherWELLMED PTAN
TX1703035-01Medicaid
TXP00164042OtherRR/MEDICARE
TX170303504Medicaid
TX1703035-01Medicaid
TX1703035-01Medicaid