Provider Demographics
NPI:1457397697
Name:WINGO, SUSAN T (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:WINGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1215 S COULTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1769
Mailing Address - Country:US
Mailing Address - Phone:806-350-7307
Mailing Address - Fax:806-677-2024
Practice Address - Street 1:1301 S COULTER ST
Practice Address - Street 2:SUITE 106
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1763
Practice Address - Country:US
Practice Address - Phone:806-350-7307
Practice Address - Fax:806-677-2024
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6722207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163988202Medicaid
TX341272ZGPNMedicare UPIN
TX8B2431Medicare ID - Type Unspecified