Provider Demographics
NPI:1477565364
Name:SMITH, SUZANNE M (DPM)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:3136 HORIZON RD
Mailing Address - Street 2:STE 120
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7808
Mailing Address - Country:US
Mailing Address - Phone:972-412-1347
Mailing Address - Fax:972-463-1185
Practice Address - Street 1:5700 ROWLETT RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-7922
Practice Address - Country:US
Practice Address - Phone:972-412-1347
Practice Address - Fax:972-463-1185
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX0899213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F9963Medicare PIN