Provider Demographics
NPI:1558503839
Name:SUSAN PORTNOY EPNER, M.D., P.A.
Entity Type:Organization
Organization Name:SUSAN PORTNOY EPNER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PORTNOY
Authorized Official - Last Name:EPNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-497-0494
Mailing Address - Street 1:4903 GOLDEN QUAIL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1584
Mailing Address - Country:US
Mailing Address - Phone:210-877-2727
Mailing Address - Fax:210-877-0267
Practice Address - Street 1:4903 GOLDEN QUAIL
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1584
Practice Address - Country:US
Practice Address - Phone:210-877-2727
Practice Address - Fax:210-877-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104240003Medicaid
TX0066TEOtherBCBS GROUP
TX8CG786OtherBCBS INDIVIDUAL
TX8L25706Medicare PIN
TX0066TEOtherBCBS GROUP
TXG95985Medicare UPIN