Individual
DR. NICOLE MARIE SURDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
E4802
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
EL 1671
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E 4802
CALIFORNIA STATE LICENSE- DOCOTR OF PODIATRIC MEDICINE AND ANKLE SURGERY
CA
01
—
EL 1671
D.P.M. RESIDENT'S LICENSE
CA
Enumeration date
01/15/2007
Last updated
02/07/2012
Update your record
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