Individual
OTTO C. SUSEC JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 497-5929
(843) 497-9940
Mailing address
5402 PHEASANT DR., N. MYRTLE BEACH, SC 29582
(843) 390-0168
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18388
SC
208D00000X
General Practice Physician
01065993A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T23285
—
SC
Enumeration date
07/14/2005
Last updated
04/21/2022
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