Provider Demographics
NPI:1073606158
Name:HESS, SUSAN L (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:HESS
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2140
Practice Address - Fax:817-332-2506
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH04492080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137345810Medicaid
TX4526725OtherAETNA PIN
TX972170OtherUHC PIN
TX115055100OtherFIRSTCARE PIN
TX1727211OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TX140442852Medicaid
TX2808001OtherCIGNA PIN
TXB7Z126OtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TX138266501Medicaid
TX138266502Medicaid
TX10028653OtherAMERIGROUP PIN
TX103285OtherSUPERIOR PIN
TX137345810Medicaid
TX00U87ZMedicare PIN
TX1727211OtherFIRSTHEALTH PIN