Provider Demographics
NPI:1033179031
Name:HUBBARD, SUSAN JEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEANNE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:JEANNE
Other - Last Name:COLEMAN (MARRIED NAME)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5470 W LOVERS LN
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4264
Mailing Address - Country:US
Mailing Address - Phone:214-956-7337
Mailing Address - Fax:469-364-8724
Practice Address - Street 1:5470 W LOVERS LN
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4264
Practice Address - Country:US
Practice Address - Phone:214-956-7337
Practice Address - Fax:469-364-8724
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9594208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84E555OtherBCBS OF TEXAS
TXPED147Medicare UPIN