Provider Demographics
NPI:1629302542
Name:RACZ, SUZANNE ELAINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ELAINE
Last Name:RACZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:ELAINE
Other - Last Name:RACZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6301 GASTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3922
Mailing Address - Country:US
Mailing Address - Phone:214-827-3610
Mailing Address - Fax:214-443-9640
Practice Address - Street 1:6080 N CENTRAL EXPY STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5202
Practice Address - Country:US
Practice Address - Phone:214-827-3610
Practice Address - Fax:214-443-9640
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00805OtherTEXAS STATE BOARD LICENSE NUMBER