Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME43704 | FL |
Y | 208600000X | Surgeon | ME43704 | FL |
N | 2086S0129X | Vascular Surgeon | ME43704 | FL |
NPI | 1134183130 |
---|---|
Provider Name | Dr. David L Sustarsic |
First Address | Leesburg, FL 34748-7326 |
Second Address | Leesburg, FL 34748-7326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 30/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040867100 | (05) | FL |
35206 | BLUE CROSS BLUE SHIELD (01) | FL |
D54363 | (02) | FL |