Provider Demographics
NPI:1699760439
Name:JONES, SUSAN A (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2770 2ND AVE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8992
Mailing Address - Country:US
Mailing Address - Phone:337-474-0046
Mailing Address - Fax:337-474-8919
Practice Address - Street 1:2770 2ND AVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8992
Practice Address - Country:US
Practice Address - Phone:337-474-0046
Practice Address - Fax:337-474-8919
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA18234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1921564Medicaid
LA1921564Medicaid
LAF01592Medicare UPIN