Healthcare Provider Details

I. General information

NPI: 1255422945
Provider Name (Legal Business Name): ERIC ALONSO SUESCUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST SUITE 504
SARASOTA FL
34239-2943
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-1579
  • Fax: 941-917-4340
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number022991
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: