Provider Demographics
NPI:1043390222
Name:THOMAS, SUSAN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2450 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5069
Mailing Address - Country:US
Mailing Address - Phone:505-521-5381
Mailing Address - Fax:505-521-5376
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5069
Practice Address - Country:US
Practice Address - Phone:505-521-5381
Practice Address - Fax:505-521-5376
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2002-0189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine