Provider Demographics
NPI:1477639565
Name:WILLIAMS, SUSAN VANHOOK (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VANHOOK
Last Name:WILLIAMS
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 1:437 DUNMORELAND CIR
Mailing Address - Street 2:SHREVEPORT
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6101
Mailing Address - Country:US
Mailing Address - Phone:318-869-2838
Mailing Address - Fax:
Practice Address - Street 1:437 DUNMORELAND CIR
Practice Address - Street 2:SHREVEPORT
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6101
Practice Address - Country:US
Practice Address - Phone:318-869-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.016387207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB65012Medicare UPIN