Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G63205 | CA |
NPI | 1003996950 |
---|---|
Provider Name | Mark R Susskind |
First Address | Sacramento, CA 95827-2539 |
Second Address | Fairfield, CA 94533-5711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G632050 | (05) | CA |
A53730 | (02) |