Provider Demographics
NPI:1689812463
Name:SUDDERTH,JR., EARLE WARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:WARD
Last Name:SUDDERTH,JR.
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 1:920 HUEY P LONG AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6214
Mailing Address - Country:US
Mailing Address - Phone:504-421-9654
Mailing Address - Fax:504-366-0892
Practice Address - Street 1:920 HUEY P LONG AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6214
Practice Address - Country:US
Practice Address - Phone:504-421-9654
Practice Address - Fax:504-366-0892
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-01
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009381208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice