Provider Demographics
NPI:1740286764
Name:GAZDA, SUZANNE K (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:K
Last Name:GAZDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 293879
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3879
Mailing Address - Country:US
Mailing Address - Phone:210-692-1245
Mailing Address - Fax:210-692-9311
Practice Address - Street 1:1580 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3312
Practice Address - Country:US
Practice Address - Phone:210-692-1245
Practice Address - Fax:210-692-9311
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH05272084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130009034OtherRAILROAD MEDICARE
TX8AW380OtherTX BLUE CROSS BLUE SHIELD
TX120501503Medicaid
TX8F1132Medicare PIN
D66754Medicare UPIN