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General NPI Number Information
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NPI Number | 1568840767
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Entity Type | Organization
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Legal Business Name | SUSAN R DEVINE MD PA DBA DEVINE OBGYN PA
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 4403 6TH ST
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City | LUBBOCK
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State | TX
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Zip | 79416-4733
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Country | US
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Telephone | 806-791-1122
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Fax | 806-791-2252
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Provider Business Mailing Address
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Address Line | 4403 6TH ST
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City | LUBBOCK
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State | TX
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Zip | 79416-4733
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Country | US
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Telephone | 806-791-1122
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Fax | 806-791-2252
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CANDY M BUFFINGTON
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Credential | RN
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Telephone | 806-791-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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