Provider Demographics
NPI:1174620462
Name:MCLEAN, SUSAN F (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5130 GATEWAY BLVD E # 51015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1608
Mailing Address - Country:US
Mailing Address - Phone:915-215-4480
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:4801 ALBERTA AVE.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-545-7507
Practice Address - Fax:915-545-9799
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK9123208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118064802Medicaid
TX83051KOtherBCBS OF TEXAS
TX83051KMedicare ID - Type Unspecified
TXG07366Medicare UPIN