Provider Demographics
NPI:1114010154
Name:SURBER, AMBER W (MD)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:W
Last Name:SURBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-637-1595
Mailing Address - Fax:
Practice Address - Street 1:7227 N HIGHWAY 1
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-5020
Practice Address - Country:US
Practice Address - Phone:321-637-1595
Practice Address - Fax:321-637-1596
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FL51406XMedicare PIN