Provider Demographics
NPI:1225137839
Name:GRATZFELD, SUSAN D (PAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:GRATZFELD
Suffix:
Gender:F
Credentials:PAC
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 57995
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7995
Mailing Address - Country:US
Mailing Address - Phone:281-252-9993
Mailing Address - Fax:281-252-9997
Practice Address - Street 1:17448 HIGHWAY 3
Practice Address - Street 2:SUITE 130
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4197
Practice Address - Country:US
Practice Address - Phone:281-252-9993
Practice Address - Fax:281-252-9997
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00250363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE42586Medicare UPIN
TX81N009Medicare ID - Type Unspecified