Provider Demographics
NPI:1033602651
Name:SUHRSTEDT, FREDERICK JOHN III (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JOHN
Last Name:SUHRSTEDT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:SUHRSTEDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:20 MEDICAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4267
Practice Address - Country:US
Practice Address - Phone:864-522-5220
Practice Address - Fax:864-522-5296
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC525862080S0010X
KY55284208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine