Susan McDonald

Primary specialty

SpecialistTaxonomy code 174400000X

License

88493 Issued in TX

Practice address

1400 8TH Ave
Fort Worth, TX 76104-4110

Phone

(817) 269-1472

Fax

(817) 531-2939

NPI assigned

Aug 10, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lee H Mota Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470787200000",
    "number": "1295289981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 N BURLESON BLVD # 107-233",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287011",
            "telephone_number": "817-269-1472",
            "fax_number": "817-531-2939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 8TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044110",
            "telephone_number": "817-269-1472",
            "fax_number": "817-531-2939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "SUSAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-10",
        "last_updated": "2016-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "88493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "208094511",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEE",
            "last_name": "MOTA",
            "middle_name": "H",
            "credential": "CST/CSFA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Karen A. McDonald, CRNA
• Madison Duddy McDonald, CCC-SLP
• Margaret Stewart McDonald, M.S., R.D., L.D.
• Richard Scott McDonald, DDS
• Stuart D McDonald, M.D.
• Suzanne McDonald, REGISTERED NURSE
• Taylor McDonald
• Amy McDougall
• Mary McDougall
• Peter Gordon McDougall, M.D.

• Specialist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.