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General NPI Number Information
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NPI Number | 1588906218
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Entity Type | Individual
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Provider Name | SUSAN MOSES SHROPSHIRE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 4812 CAMP BOWIE BLVD SUITE B
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City | FORT WORTH
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State | TX
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Zip | 76107-4121
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Country | US
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Telephone | 817-732-5515
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Fax | 817-737-7271
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Provider Business Mailing Address
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Address Line | 4812 CAMP BOWIE BLVD SUITE B
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City | FORT WORTH
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State | TX
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Zip | 76107-4121
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Country | US
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Telephone | 817-732-5515
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Fax | 817-737-7271
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E9822
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License Number State | TX
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