Provider Demographics
NPI:1710993431
Name:WETHEROLD, SUZANNE C (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:WETHEROLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7800 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 205N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1098
Mailing Address - Country:US
Mailing Address - Phone:512-206-4341
Mailing Address - Fax:512-407-1947
Practice Address - Street 1:7800 SHOAL CREEK BLVD
Practice Address - Street 2:SUITE 205N
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1098
Practice Address - Country:US
Practice Address - Phone:512-206-4341
Practice Address - Fax:512-899-0311
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL9546207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5266Medicare PIN
TX8K5268Medicare PIN
TXI15257Medicare UPIN