Provider Demographics
NPI:1689740938
Name:SUCHSLAND, JAMES P (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:SUCHSLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2791 N WASHINGSTON ST
Mailing Address - Street 2:HEDRICK FAMILY CARE
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601
Mailing Address - Country:US
Mailing Address - Phone:660-646-2682
Mailing Address - Fax:660-214-8611
Practice Address - Street 1:2791 N WASHINGSTON ST
Practice Address - Street 2:HEDRICK FAMILY CARE
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601
Practice Address - Country:US
Practice Address - Phone:660-646-2682
Practice Address - Fax:660-214-8611
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR6206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241904903Medicaid
MO241904903Medicaid
MOE48243Medicare UPIN