Sudderth, Stephen D
Sudderth, Stephen D is an sole proprietor health care provider with primary practice located at 188 Ymca Pl , Vicksburg MS 39183-3536. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Sudderth, Stephen D can be contacted via phone (601) 636-7222.Contact Information
Primary practice address
188 Ymca Pl
Vicksburg MS 39183-3536
Phone: (601) 636-7222
Fax: (601) 636-0440
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 17597 | Mississippi |
Profile Details
| NPI number | 1528096849 |
|---|---|
| LBN Legal business name | Sudderth, Stephen D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 28th, 2006 |
| Last updated | Feb 21st, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528096849 | NPPES |
| Mississippi | MEDICAID | 00126115 | |
| Mississippi | MEDICAID | 1986712 |
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