Provider Demographics
NPI:1104039601
Name:SUCHMAN, DAVID IRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IRA
Last Name:SUCHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 NW 12TH AVE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4133
Mailing Address - Country:US
Mailing Address - Phone:352-338-1212
Mailing Address - Fax:352-392-8452
Practice Address - Street 1:1212 NW 12TH AVE
Practice Address - Street 2:SUITE C-2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3032
Practice Address - Country:US
Practice Address - Phone:352-338-1212
Practice Address - Fax:352-392-8452
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75210OtherBLUE CROSS-BLUE SHIELD