Provider Demographics
NPI:1881682144
Name:MCBRIDE, SUZANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2315 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-7552
Mailing Address - Country:US
Mailing Address - Phone:850-436-4630
Mailing Address - Fax:
Practice Address - Street 1:2315 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-7552
Practice Address - Country:US
Practice Address - Phone:850-436-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26551207Q00000X
FLME142844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104851600Medicaid
GAP01365183OtherRAILROAD MEDICARE
GA972580309EMedicaid
I35804Medicare UPIN
GA972580309EMedicaid
GA202I081204Medicare PIN
GA511I080630Medicare PIN