Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD.3266 | AL |
NPI | 1033413489 |
---|---|
Provider Name | Dr. Roger Carlisle Suttle Jr |
First Address | Gadsden, AL 35901-5215 |
Second Address | Gadsden, AL 35901-5215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2010 |
Last Update Date | 28/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6232 | (05) | AL |