Provider Demographics
NPI:1871550160
Name:SMART, SUSAN MICHAELLE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MICHAELLE
Last Name:SMART
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:804 TRUMPETER WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5856
Mailing Address - Country:US
Mailing Address - Phone:469-698-9335
Mailing Address - Fax:972-412-1949
Practice Address - Street 1:9100 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4537
Practice Address - Country:US
Practice Address - Phone:972-412-3034
Practice Address - Fax:972-412-1949
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL1753208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G9352OtherBLUE CROSS BLUE SHIELD