Doctor Name: | DR. JAMES DAVID SURSO |
NPI Number: | 1073632774 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 19488 |
Business Practice Address: | 2975 Highway 101 Rogersville, AL - 356526049 |
Business Phone Number: | 2562472007 |
Business Fax Number: | 2562472008 |
Mailing Address: | 643 County Road 71, KILLEN |
State: | AL |
Postal Code: | 356456311 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 19488 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |