Doctor Name: | DR. SURESH V DUTTA |
NPI Number: | 1992769137 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | L1024 |
Business Practice Address: | 1010 Nw Loop 410 Suite 100d San Antonio, TX - 782132220 |
Business Phone Number: | 2103089999 |
Business Fax Number: | 2103086262 |
Mailing Address: | 1010 Nw Loop 410, Suite 100d SAN ANTONIO |
State: | TX |
Postal Code: | 782132220 |
Phone Number: | 2103089999 |
Fax Number: | 2103086262 |
NPI Enumeration Date: | 04/14/2006 |
NPI Last Update Date: | 03/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | L1024 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |