Provider Demographics
NPI:1275567620
Name:ARIZPE, SUZAN JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:JANE
Last Name:ARIZPE
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:PO BOX 170687
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0033
Mailing Address - Country:US
Mailing Address - Phone:512-250-9140
Mailing Address - Fax:512-250-2207
Practice Address - Street 1:13009 SCOFIELD FARMS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4599
Practice Address - Country:US
Practice Address - Phone:512-250-9140
Practice Address - Fax:512-250-2207
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ77299207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165593802Medicaid
TXG18142Medicare UPIN
TXTXB101554Medicare PIN
TX165593802Medicaid