Provider Demographics
NPI:1265453179
Name:SUESCUN, CARLOS ALBERTO JR (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:SUESCUN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6169
Mailing Address - Country:US
Mailing Address - Phone:480-626-1314
Mailing Address - Fax:480-993-2306
Practice Address - Street 1:10900 N SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 603
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5216
Practice Address - Country:US
Practice Address - Phone:480-607-3800
Practice Address - Fax:480-607-3808
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35723207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119342-01Medicaid
I58501OtherDEA
AZP00372650Medicare PIN
I58501OtherDEA
AZI58501Medicare UPIN