Provider Demographics
NPI:1710949698
Name:SUZANNE K. GAZDA, MD, PA
Entity Type:Organization
Organization Name:SUZANNE K. GAZDA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GAZDA
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:210-692-1245
Mailing Address - Street 1:PO BOX 293879
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3879
Mailing Address - Country:US
Mailing Address - Phone:210-692-1245
Mailing Address - Fax:210-692-9311
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:#6100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5640
Practice Address - Country:US
Practice Address - Phone:210-692-1245
Practice Address - Fax:210-692-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH05272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035RAOtherTX BCBS
TX00495ZMedicare ID - Type Unspecified