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General NPI Number Information
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NPI Number | 1184651192
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Entity Type | Individual
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Provider Name | ROBERT HERDMAN SUDDUTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2200 NW MYHRE RD
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City | SILVERDALE
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State | WA
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Zip | 98383-7681
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Country | US
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Telephone | 360-830-1205
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Fax | 360-830-1281
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Provider Business Mailing Address
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Address Line | 9621 RIDGETOP BLVD NW
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City | SILVERDALE
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State | WA
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Zip | 98383-8502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD00025993
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00025993
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License Number State | WA
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