# SUSAN VAN DE WATER, MD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376867937
- **Authorized official:** DR. SUSAN DEAN VAN DE WATER MD (PRESIDENT)
- **Authorized official phone:** (432) 570-0373

## Contact information

- **Practice address:** 1030 N GRANDVIEW AVE, ODESSA, TX 79761-3149
- **Practice address phone:** (432) 570-0373
- **Practice address fax:** (432) 687-3143
- **Mailing address:** PO BOX 62227, MIDLAND, TX 79711-2227
- **Mailing address phone:** (432) 570-0373
- **Mailing address fax:** (432) 687-3143

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | H2869 | TX | Yes |

## Other

- **Enumeration date:** 03/24/2010
- **Last updated:** 05/28/2013