Provider Demographics
NPI:1588906218
Name:SHROPSHIRE, SUSAN MOSES (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MOSES
Last Name:SHROPSHIRE
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 1:4812 CAMP BOWIE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4121
Mailing Address - Country:US
Mailing Address - Phone:817-732-5515
Mailing Address - Fax:817-737-7271
Practice Address - Street 1:4812 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4121
Practice Address - Country:US
Practice Address - Phone:817-732-5515
Practice Address - Fax:817-737-7271
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9822208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice