Healthcare Provider Details

I. General information

NPI: 1538510664
Provider Name (Legal Business Name): SUZANNA ELIZABETH MAUPIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7355 BARLITE BLVD STE 201
SAN ANTONIO TX
78224-1340
US

IV. Provider business mailing address

PO BOX 830605
SAN ANTONIO TX
78283-0605
US

V. Phone/Fax

Practice location:
  • Phone: 210-222-0333
  • Fax: 210-928-4837
Mailing address:
  • Phone: 210-222-0333
  • Fax: 210-928-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS3239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: