Provider Demographics
NPI:1508841453
Name:SUESS, FRED (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:SUESS
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 1:1700 CALIFORNIA ST., SUITE #500
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-0430
Mailing Address - Country:US
Mailing Address - Phone:415-567-1795
Mailing Address - Fax:415-567-4906
Practice Address - Street 1:1700 CALIFORNIA ST
Practice Address - Street 2:STE 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-0430
Practice Address - Country:US
Practice Address - Phone:415-567-1791
Practice Address - Fax:415-567-4906
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG262662086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42955Medicare UPIN
CA0041262660Medicare ID - Type Unspecified