Provider Demographics
NPI:1154317576
Name:ANDREW, SUSAN L (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:ANDREW
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 1:914 FM 517 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3923
Mailing Address - Country:US
Mailing Address - Phone:281-337-1512
Mailing Address - Fax:281-534-1472
Practice Address - Street 1:914 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3923
Practice Address - Country:US
Practice Address - Phone:281-337-1512
Practice Address - Fax:281-534-1472
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3976207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82G537OtherBLUE CROSS
TX081517701Medicaid
TX4500496724OtherCLIA
TX00A14WMedicare ID - Type Unspecified
TX081517701Medicaid