Healthcare Provider Details

I. General information

NPI: 1043264419
Provider Name (Legal Business Name): STEVEN J SUKSTORF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 N DAVIS HWY STE 1B
PENSACOLA FL
32503-2720
US

IV. Provider business mailing address

602 HARBOR BLVD UNIT 101
DESTIN FL
32541-2480
US

V. Phone/Fax

Practice location:
  • Phone: 850-484-8454
  • Fax:
Mailing address:
  • Phone: 850-974-1723
  • Fax: 850-654-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME47793
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME47793
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME47793
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME47793
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME47793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: