Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 7845 | MS |
NPI | 1003854670 |
---|---|
Provider Name | Edwin P Sudduth |
First Address | Jackson, MS 39216-4643 |
Second Address | Jackson, MS 39216-4643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00018142 | (05) | MS |
B31158 | (02) | MS |