MEDICARE: SUSAN CAROL GUBA MD

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	207RH0003X	Hematology & Oncology Physician	L1056	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558350462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CAROL GUBA MD

Provider Business Mailing Address
First Line	:	8440 WALNUT HILL LN
Second Line	:	SUITE 600
City	:	DALLAS
State	:	TX
Zip	:	75231-3833
Country	:	US
Telephone Number	:	214-739-1706
Fax Number	:	214-368-0056

Provider Business Practice Location Address
First Line	:	8440 WALNUT HILL LN
Second Line	:	SUITE 600
City	:	DALLAS
State	:	TX
Zip	:	75231-3833
Country	:	US
Telephone Number	:	214-739-1706
Fax Number	:	214-368-0056

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	12/11/2008

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Directions to “ SUSAN CAROL GUBA MD” Practice Location

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