Provider Demographics
NPI:1356339840
Name:OON, SU-MIN (MD)
Entity type:Individual
Prefix:
First Name:SU-MIN
Middle Name:
Last Name:OON
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 1:777 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2102
Mailing Address - Country:US
Mailing Address - Phone:478-633-5556
Mailing Address - Fax:
Practice Address - Street 1:1131 NW 64TH TER
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4218
Practice Address - Country:US
Practice Address - Phone:352-331-5557
Practice Address - Fax:352-331-5510
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76691207LP2900X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261327100Medicaid
FL276243OtherAVMED
FL51058OtherBLUE CROSS BLUE SHIELD
FL261327100Medicaid
FLH39027Medicare UPIN