Provider Demographics
NPI:1821058132
Name:LINDER, SUSAN KEITH (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KEITH
Last Name:LINDER
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:PO BOX 961013
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-0013
Mailing Address - Country:US
Mailing Address - Phone:817-926-7671
Mailing Address - Fax:817-926-7772
Practice Address - Street 1:2800 S HULEN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1504
Practice Address - Country:US
Practice Address - Phone:817-926-7671
Practice Address - Fax:817-926-7772
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8972208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSOther00L11W
TX250007140Medicare PIN
TX00L11WMedicare PIN
TXBCBSOther00L11W
F73989Medicare UPIN