Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 18449 | DC |
N | 207L00000X | Anesthesiologist | 2015019918 | MO |
Y | 207L00000X | Anesthesiologist | 2021-02174 | NC |
NPI | 1013917855 |
---|---|
Provider Name | Johan Suyderhoud |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 29/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2015019918 | LICENSE (01) | MO |
E69691 | (02) |