Provider Demographics
NPI:1376684258
Name:PHILLIP SUFFRIDGE,M.D.,P.A.
Entity Type:Organization
Organization Name:PHILLIP SUFFRIDGE,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SUFFRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-778-1113
Mailing Address - Street 1:3 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3728
Mailing Address - Country:US
Mailing Address - Phone:501-778-1113
Mailing Address - Fax:501-778-5391
Practice Address - Street 1:3 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3728
Practice Address - Country:US
Practice Address - Phone:501-778-1113
Practice Address - Fax:501-778-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06040018300OtherQUALCHOICE
AR06040018300OtherQUALCHOICE
AR06040018300OtherQUALCHOICE
AR5N525Medicare ID - Type Unspecified