Provider Demographics
NPI:1245233188
Name:GRAHAM, SUZANNE CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:CAROL
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-3596
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:1A115
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2155
Practice Address - Fax:806-743-2117
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2131207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52423OtherPRESBYTERIAN COMMERCIAL
TX80815ZOtherHMO BLUE
TX82P193OtherBLUE CROSS & BLUE SHEILD
NM52423Medicaid
NMV9653Medicaid
A077OtherTRIWEST
A077OtherTRIWEST
NM52423Medicaid