Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G53084 | CA |
NPI | 1124020136 |
---|---|
Provider Name | Dr. Richard W Suda |
First Address | Glendale, CA 91204-2500 |
Second Address | Glendale, CA 91204-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E89868 | (02) | CA |
GR0086630 | (05) | CA |