Healthcare Provider Details

I. General information

NPI: 1104039601
Provider Name (Legal Business Name): DAVID IRA SUCHMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 NW 12TH AVE SUITE C-2
GAINESVILLE FL
32601-3032
US

IV. Provider business mailing address

1212 NW 12TH AVE SUITE C-2
GAINESVILLE FL
32601-4133
US

V. Phone/Fax

Practice location:
  • Phone: 352-338-1212
  • Fax: 352-392-8452
Mailing address:
  • Phone: 352-338-1212
  • Fax: 352-392-8452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 2797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: