Provider Demographics
NPI:1801107388
Name:SUAREZ GONZALEZ, VIVIAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:MARIE
Last Name:SUAREZ GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:MARIE
Other - Last Name:SUAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11215 METRO PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1206
Mailing Address - Country:US
Mailing Address - Phone:239-208-2212
Mailing Address - Fax:239-208-3994
Practice Address - Street 1:11215 METRO PKWY STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:239-208-3994
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4720502084N0400X
AZ563652084N0400X
TN578632084N0400X
FLME1364592084N0400X
CAC1516002084N0400X
NMTM2018-02362084N0400X
NY2575552084N0400X
MI43011170472084N0400X
TXTM007732084N0400X
NH188872084N0400X
WAMD606100972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3117854Medicaid