Provider Demographics
NPI:1669557286
Name:SUESS, LAWRENCE E (DO)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:SUESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N CALIFORNIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6032
Mailing Address - Country:US
Mailing Address - Phone:209-645-4005
Mailing Address - Fax:209-645-6344
Practice Address - Street 1:1805 N CALIFORNIA ST STE 201
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6032
Practice Address - Country:US
Practice Address - Phone:209-645-4005
Practice Address - Fax:209-645-6344
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A176352084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA398197OtherCA MEDICARE
KY64023187Medicaid
KY0955701Medicare ID - Type Unspecified