Provider Demographics
NPI:1336368455
Name:ALEXANDER, SUZANNE BLAIR (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:BLAIR
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 WOODSTREAM BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2201
Mailing Address - Country:US
Mailing Address - Phone:281-980-5552
Mailing Address - Fax:281-341-3096
Practice Address - Street 1:1705 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3246
Practice Address - Country:US
Practice Address - Phone:281-633-4028
Practice Address - Fax:281-341-3096
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered