Provider Demographics
NPI:1427059401
Name:SPALDING, SUSAN H (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:SPALDING
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 HARRY HINES BLVD
Practice Address - Street 2:HOMES
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7721
Practice Address - Country:US
Practice Address - Phone:214-590-0153
Practice Address - Fax:214-590-0172
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3233208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139129412Medicaid
TX139129401Medicaid
TX139129403Medicaid
TX139129406Medicaid
TX139129410Medicaid
TX89G956OtherBLUE CROSS BLUE SHIELD
TX139129402Medicaid
TX139129404Medicaid
TX139129414Medicaid
TX139129405Medicaid
TX139129407Medicaid
TX139129408Medicaid
TX139129413Medicaid
TX139129416Medicaid
TX139129412Medicaid
TX8639N7Medicare PIN