Provider Demographics
NPI:1275532715
Name:TSUDA, SUE (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:TSUDA
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 1:2605 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6133
Mailing Address - Country:US
Mailing Address - Phone:501-327-2995
Mailing Address - Fax:501-327-2331
Practice Address - Street 1:2605 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6133
Practice Address - Country:US
Practice Address - Phone:501-327-2995
Practice Address - Fax:501-327-2331
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8494207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123637001Medicaid
AR1962618769OtherBREAST CARE
AR1962618769OtherBREAST CARE
AR5J183F654Medicare PIN