Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MA050043 | NJ |
NPI | 1992812275 |
---|---|
Provider Name | Dr. James Noland Suddeth |
First Address | Ship Bottom, NJ 08008-4443 |
Second Address | Ship Bottom, NJ 08008-4443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 05/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6175708 | (05) | NJ |
B94862 | (02) | NJ |