Healthcare Provider Details

I. General information

NPI: 1629103205
Provider Name (Legal Business Name): DAVID P SUCHARD III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N DUTTON AVE STE 244
SANTA ROSA CA
95401-4672
US

IV. Provider business mailing address

1260 N DUTTON AVE STE 244
SANTA ROSA CA
95401-4672
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-2880
  • Fax: 707-546-2828
Mailing address:
  • Phone: 707-546-2880
  • Fax: 707-546-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG77725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: