Provider Demographics
NPI:1215348826
Name:SUZELLE L. MOFFITT, M.D., P.A.
Entity type:Organization
Organization Name:SUZELLE L. MOFFITT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-370-6290
Mailing Address - Street 1:4002 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1139
Mailing Address - Country:US
Mailing Address - Phone:806-370-6290
Mailing Address - Fax:806-300-0211
Practice Address - Street 1:4002 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1139
Practice Address - Country:US
Practice Address - Phone:806-370-6290
Practice Address - Fax:806-300-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty