Provider Demographics
NPI:1952404568
Name:EPNER, SUSAN PORTNOY (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PORTNOY
Last Name:EPNER
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 1:8715 VILLAGE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5407
Mailing Address - Country:US
Mailing Address - Phone:210-732-3668
Mailing Address - Fax:210-732-3338
Practice Address - Street 1:8715 VILLAGE DR STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5407
Practice Address - Country:US
Practice Address - Phone:210-732-3668
Practice Address - Fax:210-732-3338
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK43092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066TEOtherBCBS GROUP
TX8CG786OtherBCBS
TX104240003Medicaid
G95985Medicare UPIN
TX8CG786OtherBCBS
TX0A4953Medicare PIN
TX0066TEOtherBCBS GROUP