Provider Demographics
NPI:1326127085
Name:SUAREZ, PHILIP T (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:T
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3127
Mailing Address - Country:US
Mailing Address - Phone:361-578-5233
Mailing Address - Fax:361-578-0085
Practice Address - Street 1:110 MEDICAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3127
Practice Address - Country:US
Practice Address - Phone:361-578-5233
Practice Address - Fax:361-578-0085
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8856207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX816563Medicare ID - Type Unspecified
TXE65020Medicare UPIN