Provider Demographics
NPI:1528023900
Name:SUAREZ, AGUSTIN J (MD)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:J
Last Name:SUAREZ
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 1:1513 MCNEILL STEEPHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-9168
Mailing Address - Country:US
Mailing Address - Phone:601-749-4503
Mailing Address - Fax:
Practice Address - Street 1:1513 MCNEILL STEEPHOLLOW RD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-9168
Practice Address - Country:US
Practice Address - Phone:601-749-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04335R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1349151Medicaid
LA5M551Medicare PIN
B61884Medicare UPIN