Healthcare Provider Details

I. General information

NPI: 1699744136
Provider Name (Legal Business Name): JOSEPH STEPHEN SUSA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BUTLER ST SUITE 115
DALLAS TX
75235-7828
US

IV. Provider business mailing address

2110 RESEARCH ROW STE 100
DALLAS TX
75235-2520
US

V. Phone/Fax

Practice location:
  • Phone: 214-530-5200
  • Fax: 214-530-5211
Mailing address:
  • Phone: 214-530-5200
  • Fax: 214-530-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberM2136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: