Healthcare Provider Details

I. General information

NPI: 1881863793
Provider Name (Legal Business Name): LUIS SUAREZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 RICHARDS RD
AUGUSTA GA
30906-2837
US

IV. Provider business mailing address

2233 RICHARDS RD
AUGUSTA GA
30906-2837
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-5900
  • Fax:
Mailing address:
  • Phone: 706-364-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number16491
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: