Provider Demographics
NPI:1578754149
Name:SUIT, CAROL TRACY (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:TRACY
Last Name:SUIT
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 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4900 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9109
Practice Address - Country:US
Practice Address - Phone:575-492-5000
Practice Address - Fax:575-492-5505
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-1215207V00000X
TXL0628207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039990905Medicaid
TX125006103OtherFIRSTCARE
TX8BS954OtherBCBS
TX125006103OtherFIRSTCARE