Provider Demographics
NPI:1629103205
Name:SUCHARD, DAVID P III (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:SUCHARD
Suffix:III
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 1:1260 N DUTTON AVE STE 244
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4672
Mailing Address - Country:US
Mailing Address - Phone:707-546-2880
Mailing Address - Fax:707-546-2828
Practice Address - Street 1:1260 N DUTTON AVE STE 244
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4672
Practice Address - Country:US
Practice Address - Phone:707-546-2880
Practice Address - Fax:707-546-2828
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist