Provider Demographics
NPI:1053317743
Name:NORTHCUTT, SUZANNE N (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:N
Last Name:NORTHCUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:ESCUDIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27476
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0476
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:STE 1C282
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8182
Practice Address - Country:US
Practice Address - Phone:806-743-2981
Practice Address - Fax:806-743-2984
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0154207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106163201Medicaid
TX112357100OtherFIRSTCARE COMMERCIAL
TX84337ZOtherHMO BLUE
OK100159300AMedicaid
TX106163202Medicaid
NM69256Medicaid
A401OtherTRIWEST
NM69256OtherPRESBYTERIAN COMMERCIAL
TX82631XOtherBLUE CROSS & BLUE SHIELD
TX112357102Medicaid
NMG0808Medicaid