Provider Demographics
NPI:1487630372
Name:HONG, SUZETTE C (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:C
Last Name:HONG
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 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8987207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EH095OtherBCBS TX
TX118124003Medicaid
TX118124007Medicaid
TX118124040Medicaid
TX83790KOtherBCBS
TX118124002Medicaid
TX118124004Medicaid
TX050065088OtherRAILROAD
TX118124006Medicaid
TXP0837901KMedicaid
TX050065088OtherRAILROAD
F64391Medicare UPIN
TXTXB125443Medicare PIN
TX118124002Medicaid
TX118124003Medicaid
TXP0837901KMedicaid