Provider Demographics
NPI:1356324461
Name:SURDYKA, DAVID GUY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GUY
Last Name:SURDYKA
Suffix:
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 1:17100B BEAR VALLEY RD # 283
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5851
Mailing Address - Country:US
Mailing Address - Phone:760-552-8585
Mailing Address - Fax:
Practice Address - Street 1:12490 BUSINESS CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5833
Practice Address - Country:US
Practice Address - Phone:760-552-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66992207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG066992OtherCALIFORNIA MEDICAL LICENSE NUMBER
F12020Medicare UPIN