Provider Demographics
NPI:1467566521
Name:SUARES, ROBERT NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEAL
Last Name:SUARES
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38702-0749
Mailing Address - Country:US
Mailing Address - Phone:662-334-9829
Mailing Address - Fax:662-334-3529
Practice Address - Street 1:344 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4711
Practice Address - Country:US
Practice Address - Phone:662-334-8578
Practice Address - Fax:662-334-8563
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016504Medicaid
DE1802OtherRAILROAD MEDICARE
AR1078470001OtherARKANSAS MEDICAID
MS00016504Medicaid
AR1078470001OtherARKANSAS MEDICAID
MS180000358Medicare PIN