Provider Demographics
NPI:1740246909
Name:STANKO, SUE E (MD)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:E
Last Name:STANKO
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 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:1201 HEWITT DR STE 204
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8834
Practice Address - Country:US
Practice Address - Phone:254-741-9933
Practice Address - Fax:254-741-9941
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
121203706OtherEPSD
TX121203705Medicaid
TX121203705Medicaid