Provider Demographics
NPI:1144408261
Name:MARTIN, SUZANNE THOMPSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:THOMPSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WOODBRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7060
Mailing Address - Country:US
Mailing Address - Phone:972-442-2300
Mailing Address - Fax:
Practice Address - Street 1:501 WOODBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7060
Practice Address - Country:US
Practice Address - Phone:972-442-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02050363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical