Provider Demographics
NPI:1780977967
Name:SURAK, GARY SVRAKIC (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:SVRAKIC
Last Name:SURAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1301
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-1301
Mailing Address - Country:US
Mailing Address - Phone:740-259-0300
Mailing Address - Fax:740-259-6191
Practice Address - Street 1:10701 US 23 SOUTH
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648
Practice Address - Country:US
Practice Address - Phone:740-259-0300
Practice Address - Fax:740-259-6191
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35060677208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine