Provider Demographics
NPI:1699744136
Name:SUSA, JOSEPH STEPHEN (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:SUSA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2110 RESEARCH ROW
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2520
Mailing Address - Country:US
Mailing Address - Phone:214-530-5200
Mailing Address - Fax:214-530-5211
Practice Address - Street 1:2330 BUTLER ST
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7828
Practice Address - Country:US
Practice Address - Phone:214-530-5200
Practice Address - Fax:214-530-5211
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM2136207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176911901Medicaid
8G0949Medicare ID - Type Unspecified
TX176911901Medicaid