Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | L5578 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | L5578 | TX |
NPI | 1114902517 |
---|---|
Provider Name | Dr. Robert Neil Suter |
First Address | Garland, TX 75042-5738 |
Second Address | Garland, TX 75042-5738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 15/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180363704 | (05) | TX |
8CW469 | BLUE CROSS (01) | TX |
I36595 | (02) | TX |