Provider Demographics
NPI:1407808488
Name:STRATE, SUSAN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:STRATE
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 930
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76307-0930
Mailing Address - Country:US
Mailing Address - Phone:940-696-7578
Mailing Address - Fax:940-692-0875
Practice Address - Street 1:5420 KELL WEST BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1610
Practice Address - Country:US
Practice Address - Phone:940-696-7578
Practice Address - Fax:940-692-0875
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2035207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124819705Medicaid
C22340Medicare UPIN
TXCL8344Medicare PIN
TX124819705Medicaid