Provider Demographics
NPI:1033223847
Name:THOMPSON, SUZY (MD)
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:
Last Name:THOMPSON
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-962-9022
Mailing Address - Fax:954-966-3616
Practice Address - Street 1:3950 N 46TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1726
Practice Address - Country:US
Practice Address - Phone:954-962-9022
Practice Address - Fax:954-966-3616
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137896208000000X
VA0101232027208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101528300Medicaid