Healthcare Provider Details

I. General information

NPI: 1013232289
Provider Name (Legal Business Name): RYAN STARK SUPLEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CATTLEMEN RD STE 206
SARASOTA FL
34232-6058
US

IV. Provider business mailing address

3333 CATTLEMEN RD STE 206
SARASOTA FL
34232-6058
US

V. Phone/Fax

Practice location:
  • Phone: 941-341-0042
  • Fax:
Mailing address:
  • Phone: 941-966-4374
  • Fax: 941-342-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number280720
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME124998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: