Provider Demographics
NPI:1316928740
Name:SUTHUN, PARISA ANN (MD)
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:ANN
Last Name:SUTHUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 N STATE HWY 161
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:214-689-7806
Mailing Address - Fax:214-689-5970
Practice Address - Street 1:7200 N STATE HWY 161
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039
Practice Address - Country:US
Practice Address - Phone:214-689-7806
Practice Address - Fax:214-689-5970
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4335207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB147582OtherMEDICARE
TX175368303Medicaid
TX175368304OtherMEDICAID OTHER
TX175368301Medicaid
TX175368303Medicaid
TX175368301Medicaid
TX175368301Medicaid