MEDICARE: DR. SUSAN CAROL PENFIELD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	F5692	TX

General Provider Information

NPI Number	:	1487771457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN CAROL PENFIELD M.D.

Provider Business Mailing Address
First Line	:	1100 W 49TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3101
Country	:	US
Telephone Number	:	512-458-7455
Fax Number	:	512-458-7601

Provider Business Practice Location Address
First Line	:	1100 W 49TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3101
Country	:	US
Telephone Number	:	512-458-7455
Fax Number	:	512-458-7601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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