Provider Demographics
NPI:1508840125
Name:DIAMOND, SUSAN A (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6254
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-798-6811
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3818
Practice Address - Country:US
Practice Address - Phone:210-692-7228
Practice Address - Fax:210-692-9671
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK4041207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105414002Medicaid
TX390005310OtherMEDICARE RAILROAD
TX390005310OtherMEDICARE RAILROAD
TX87450FMedicare PIN