Provider Demographics
NPI:1548234735
Name:SURRATT, JOHN PEELER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PEELER
Last Name:SURRATT
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 1:804 COHARIE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3022
Mailing Address - Country:US
Mailing Address - Phone:910-592-5583
Mailing Address - Fax:910-592-7310
Practice Address - Street 1:804 COHARIE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3022
Practice Address - Country:US
Practice Address - Phone:910-592-5583
Practice Address - Fax:910-592-7310
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17444207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8981010Medicaid
NC81010OtherBLUE CROSS BLUE SHIELD
NC8981010Medicaid
201731AMedicare ID - Type Unspecified