Provider Demographics
NPI:1548395205
Name:SMITH, SUSAN SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SHARON
Last Name:SMITH
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 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3123207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01356088OtherRR
TX110234506Medicaid
TX8EH498OtherBCBS
TX110234514Medicaid
TXC21993Medicare UPIN
TX110234506Medicaid
TX110234514Medicaid
TXP00957370OtherRR MEDICARE
TXC21993Medicare UPIN
TX00A14EMedicare ID - Type Unspecified
TX110234508Medicaid
TXTXB119538Medicare PIN
TX110234512OtherMEDICAID CSHCN
TX110234511Medicare Oscar/Certification
TX8L23351Medicare PIN