Individual
JOHAN SUYDERHOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
18449
DC
207L00000X
Anesthesiology Physician
2015019918
MO
207L00000X
Anesthesiology Physician
Primary
2021-02174
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015019918
LICENSE
MO
Enumeration date
07/22/2005
Last updated
07/29/2021
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