Basic Information
| Provider Information | |||||||||
| NPI: | 1700896313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUYNES | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2710 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750198710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722589570 | ||||||||
| FaxNumber: | 9722589569 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 E LEE AVE | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176374358 | ||||||||
| FaxNumber: | 8175945870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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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 | 2084P0800X | H9968 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 260045675 | 01 | TX | MEDICARE RAILROAD | OTHER | 138008107 | 05 | TX | MEDICAID | 8393K0 | 01 | TX | BLUE CROSS BLUE SHIELD TEXAS | OTHER |