Provider Demographics
NPI:1043264419
Name:SUKSTORF, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:SUKSTORF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:602 HARBOR BLVD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2480
Mailing Address - Country:US
Mailing Address - Phone:850-974-1723
Mailing Address - Fax:850-654-5059
Practice Address - Street 1:4511 N DAVIS HWY
Practice Address - Street 2:STE 1B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2720
Practice Address - Country:US
Practice Address - Phone:850-484-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME477932085N0700X, 2085N0904X, 2085P0229X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048546200Medicaid
FLZ314OtherHEALTHEASE MED 3000
FLZ314OtherVISTA 26 MED 3000
FLZ314OtherWELLCARE HMO MED 3000
FLE7031AOtherMEDICARE-IDTF
FL048546200Medicaid