Individual
DR. SUAT CHENG GO FANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3804 21ST ST STE C, LUBBOCK, TX 79410-1012
(806) 795-9326
(806) 795-4835
Mailing address
3804 21ST ST STE C, LUBBOCK, TX 79410-1012
(806) 795-9326
(806) 795-4835
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
—
TX
302R00000X
Health Maintenance Organization
—
TX
305R00000X
Preferred Provider Organization
—
TX
305S00000X
Point of Service
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00BK52
BLUE CROSS BLUE SHIELD ID
TX
01
—
2315562
BLUE CROSS/ BLUE SHIELD
TX
Enumeration date
08/01/2006
Last updated
09/11/2025
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