Healthcare Provider Details

I. General information

NPI: 1033223847
Provider Name (Legal Business Name): SUZY THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 N 46TH AVE
HOLLYWOOD FL
33021-1726
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-9022
  • Fax: 954-966-3616
Mailing address:
  • Phone: 954-962-9022
  • Fax: 954-966-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME137896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: