Provider Demographics
NPI:1902805856
Name:SUDDERTH, DAVID B (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:SUDDERTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3210 CLEVELAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7182
Mailing Address - Country:US
Mailing Address - Phone:239-936-6778
Mailing Address - Fax:239-210-0225
Practice Address - Street 1:3210 CLEVELAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7182
Practice Address - Country:US
Practice Address - Phone:239-936-6778
Practice Address - Fax:239-210-0225
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME551972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1902805856OtherNPI
FL08754OtherBCBS
FL08754KMedicare PIN