Provider Demographics
NPI:1639170202
Name:EASLEY, SUSAN KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KAY
Last Name:EASLEY
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 1:609 CONSTELLATION BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6431
Mailing Address - Country:US
Mailing Address - Phone:832-932-5812
Mailing Address - Fax:
Practice Address - Street 1:2027 61ST ST
Practice Address - Street 2:WEST ISLE URGENT CARE
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77561
Practice Address - Country:US
Practice Address - Phone:409-744-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD042889OtherJHHC PROVIDER NUMBER
MD611088-01OtherCAREFIRST MD RENDERING
MD8107595OtherMAMSI PRIMARY CARE
MD2107595OtherMAMSI SPECIALIST
MD080186598OtherRR MEDICARE
MDP15034OtherCAREFIRST MPOS
MD2618832OtherAETNA CAPITATED
MD7135255OtherAETNA FEE FOR SERVICE
MD451350900Medicaid
MD7605-0049OtherCAREFIRST BLUECHOICE
MD0621984OtherCIGNA PIN
MD611088-01OtherCAREFIRST MD RENDERING
MD451350900Medicaid