Provider Demographics
NPI:1275561334
Name:SUFFRIDGE, TONYA (DO)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SUFFRIDGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:STE 26
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4595
Mailing Address - Country:US
Mailing Address - Phone:281-374-9700
Mailing Address - Fax:281-370-8765
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:STE 26
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4595
Practice Address - Country:US
Practice Address - Phone:281-374-9700
Practice Address - Fax:281-370-8765
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70477Medicare UPIN
OK100223180AMedicaid
249425304Medicare ID - Type Unspecified