Provider Demographics
NPI:1982842357
Name:SUSAN PAYBERAH, MD, P.A.
Entity Type:Organization
Organization Name:SUSAN PAYBERAH, MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYBERAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-981-7822
Mailing Address - Street 1:6300 W PARKER RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-981-7822
Mailing Address - Fax:
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-981-7822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXJ6292261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty