Basic Information
| Provider Information | |||||||||
| NPI: | 1225137839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRATZFELD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | P.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 57995 | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775987995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812529993 | ||||||||
| FaxNumber: | 2812529997 | ||||||||
| Practice Location | |||||||||
| Address1: | 17448 HIGHWAY 3 | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812529993 | ||||||||
| FaxNumber: | 2812529997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 00250 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.