Provider Demographics
NPI:1598762429
Name:DAVIS, SUZANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:DUGOPOLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 2146
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:972-569-9904
Mailing Address - Fax:972-569-9943
Practice Address - Street 1:5333 WEST UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:972-569-9904
Practice Address - Fax:972-569-9943
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2007208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126629805Medicaid
G46515Medicare UPIN