Individual
JACK LEE SUDDRETH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 S ADAMS ST, PETERSBURG, VA 23808-2938
(804) 862-5000
(804) 862-5948
Mailing address
PO BOX 740209, DEPT 1041, ATLANTA, GA 30374-0209
(941) 360-1566
(941) 358-9818
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024164859
VA
Other
Enumeration date
04/04/2006
Last updated
07/08/2007
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