Provider Demographics
NPI:1962591131
Name:CHERYL SUITER MD PA
Entity type:Organization
Organization Name:CHERYL SUITER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-699-7575
Mailing Address - Street 1:PO BOX 151420
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-1420
Mailing Address - Country:US
Mailing Address - Phone:936-699-7575
Mailing Address - Fax:936-699-7576
Practice Address - Street 1:402 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3123
Practice Address - Country:US
Practice Address - Phone:936-699-7575
Practice Address - Fax:936-699-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7855207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160043202OtherMEDICARE RAILROAD
TX113483501Medicaid
TX113483501Medicaid
TX00397DMedicare ID - Type Unspecified