Basic Information
Provider Information
NPI: 1538310594
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SUAREZ
FirstName: LUIS
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5513 COURTYARD DR
Address2:  
City: AUSTIN
State: TX
PostalCode: 787313373
CountryCode: US
TelephoneNumber: 6049221266
FaxNumber:  
Practice Location
Address1: 3501 MILLS AVE
Address2: SETON SHOAL CREEK HOSPITAL
City: AUSTIN
State: TX
PostalCode: 78731
CountryCode: US
TelephoneNumber: 5123242080
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/08/2008
LastUpdateDate: 10/08/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XE9431TXY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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