Susonne Annette Ursin, M.D.

Primary specialty

Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X

License

013853 Issued in LA

Practice address

1501 Kings Hwy
Department of Pediatrics, Section of Genetics
Shreveport, LA 71103-4228

Phone

(318) 675-6076

Fax

(318) 675-6059

NPI assigned

Jul 16, 2006

Last updated

Jul 31, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248998400000",
    "number": "1700803608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF PEDIATRICS, SECTION OF GENETICS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-6076",
            "fax_number": "318-675-6059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF PEDIATRICS, SECTION OF GENETICS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-6076",
            "fax_number": "318-675-6059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URSIN",
        "first_name": "SUSONNE",
        "middle_name": "ANNETTE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2009-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "LA",
            "license": "013853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194484",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Genetics (M.D.) Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Clinical Genetics (M.D.) Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; 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.