Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G59716 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G59716 | CA |
NPI | 1114923968 |
---|---|
Provider Name | Stephen P Suzuki |
First Address | Riverside, CA 92501-1777 |
Second Address | Riverside, CA 92501-1777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200009735 | RAILROAD MEDICARE (01) | CA |
A53518 | (02) | CA |