Provider Demographics
NPI:1669459327
Name:KING, SUSAN C (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:KING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1907 CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4150
Mailing Address - Country:US
Mailing Address - Phone:512-346-7966
Mailing Address - Fax:512-346-7196
Practice Address - Street 1:1907 CYPRESS CREEK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4150
Practice Address - Country:US
Practice Address - Phone:512-346-7966
Practice Address - Fax:512-346-7196
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2011-07-22
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Provider Licenses
StateLicense IDTaxonomies
TXL1633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH40620Medicare UPIN