Provider Demographics
NPI:1982650925
Name:SUAREZ, VIVIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LAKESIDE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-5012
Mailing Address - Country:US
Mailing Address - Phone:870-265-2335
Mailing Address - Fax:
Practice Address - Street 1:129 LAKESIDE CT
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-5012
Practice Address - Country:US
Practice Address - Phone:870-265-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N203Medicare ID - Type Unspecified
ARI28746Medicare UPIN