MEDICARE: DR. VIVIANA SUAREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E4345	AR

General Provider Information

NPI Number	:	1982650925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIANA SUAREZ M.D.

Provider Business Mailing Address
First Line	:	129 LAKESIDE CT
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-5012
Country	:	US
Telephone Number	:	870-265-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 LAKESIDE CT
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-5012
Country	:	US
Telephone Number	:	870-265-2335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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