Provider Demographics
NPI:1881568723
Name:DEPUSOIR, SUSAN GAIL
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:DEPUSOIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W GULF ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-4720
Mailing Address - Country:US
Mailing Address - Phone:713-330-6384
Mailing Address - Fax:
Practice Address - Street 1:416 W GULF ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-4720
Practice Address - Country:US
Practice Address - Phone:713-330-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13078757343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)