Individual
ALISARA SUPTUESAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
42742
TX
2085R0202X
Diagnostic Radiology Physician
FTL 41869
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187729201
—
TX
01
—
187729202
CSHCN
TX
01
—
8W2045
BCBS
TX
Enumeration date
10/04/2006
Last updated
10/13/2009
Update your record
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