Provider Demographics
NPI:1427012152
Name:WADA, SUZANNE YURI (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:YURI
Last Name:WADA
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 1:3409 WORTH ST STE 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2060
Mailing Address - Country:US
Mailing Address - Phone:214-823-2533
Mailing Address - Fax:
Practice Address - Street 1:3409 WORTH ST STE 710
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2060
Practice Address - Country:US
Practice Address - Phone:214-823-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2621207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046975101Medicaid
TX88G102Medicare ID - Type Unspecified