Healthcare Provider Details

I. General information

NPI: 1013235357
Provider Name (Legal Business Name): ALAN WESLEY SUE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 04/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 4TH ST UNIT 140
BERKELEY CA
94710-1955
US

IV. Provider business mailing address

2060 4TH ST UNIT 140
BERKELEY CA
94710-1955
US

V. Phone/Fax

Practice location:
  • Phone: 510-332-2882
  • Fax: 510-332-2882
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL1790
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE-5052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: