Provider Demographics
NPI:1285822346
Name:GEORGE, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:CLEETUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 FLOWER MOUND RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3427
Mailing Address - Country:US
Mailing Address - Phone:972-874-9600
Mailing Address - Fax:214-513-9899
Practice Address - Street 1:500 FLOWER MOUND RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3427
Practice Address - Country:US
Practice Address - Phone:972-874-9600
Practice Address - Fax:214-513-9899
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0094207Q00000X
TXM8668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine