Healthcare Provider Details

I. General information

NPI: 1275567620
Provider Name (Legal Business Name): SUZAN JANE ARIZPE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13009 SCOFIELD FARMS DR
AUSTIN TX
78727-4599
US

IV. Provider business mailing address

PO BOX 170687
AUSTIN TX
78717-0033
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-9140
  • Fax: 512-250-2207
Mailing address:
  • Phone: 512-250-9140
  • Fax: 512-250-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberJ77299
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: