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General NPI Number Information
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NPI Number | 1619020203
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Entity Type | Organization
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Legal Business Name | SUZANNE E MACK, M.D., P.A.
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 728 N ELM ST
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City | DENTON
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State | TX
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Zip | 76201-2944
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Country | US
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Telephone | 940-591-8447
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Fax | 940-484-5299
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Provider Business Mailing Address
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Address Line | 728 N ELM ST
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City | DENTON
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State | TX
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Zip | 76201-2944
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Country | US
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Telephone | 940-591-8447
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Fax | 940-484-5299
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUZANNE E MACK
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Credential | MD
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Telephone | 940-591-8447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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