| Doctor Name: | DR. ROMMELLE VON SUCH |
| NPI Number: | 1124039409 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME0062070 |
| Business Practice Address: | 1 Florida Park Dr N Suite 109-110 Palm Coast, FL - 321373852 |
| Business Phone Number: | 3864453619 |
| Business Fax Number: | 3864456925 |
| Mailing Address: | 1 Florida Park Dr N, Suite 109-110 PALM COAST |
| State: | FL |
| Postal Code: | 321373852 |
| Phone Number: | 3864453619 |
| Fax Number: | 3864456925 |
| NPI Enumeration Date: | 08/11/2006 |
| NPI Last Update Date: | 09/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME0062070 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |