# T R SUGGS MD MEDICAL CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164754602
- **Authorized official:** DR. THELBERT R SUGGS MD (OWNER)
- **Authorized official phone:** (386) 698-1221

## Contact information

- **Practice address:** 300 S MAIN ST, CRESCENT CITY, FL 32112-2729
- **Practice address phone:** (386) 698-1221
- **Practice address fax:** (386) 698-1514
- **Mailing address:** PO BOX 98, CRESCENT CITY, FL 32112-0098
- **Mailing address phone:** (386) 698-1221
- **Mailing address fax:** (386) 698-1514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2010
- **Last updated:** 08/12/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 012686688 | RAILROAD MEDICARE | FL |
| 05 | — | 045328500 | — | FL |