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Individual
DR. SURESH C MISHRA
Active
Individual
DR. SURESH C MISHRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
54969
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05372
UNIVERSAL PROVIDER ID
FL
01
—
10871
BCBS PROVIDER ID
FL
05
—
255810600
—
FL
01
—
4285918
AETNA PROVIDER ID
FL
Enumeration date
07/07/2006
Last updated
10/22/2010
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