Individual
DR. STEPHEN D SUDDERTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
188 YMCA PL, VICKSBURG, MS 39183-3536
(601) 636-7222
(601) 636-0440
Mailing address
188 YMCA PL, VICKSBURG, MS 39183-3536
(601) 636-7222
(601) 636-0440
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
17597
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126115
—
MS
05
—
1986712
—
LA
Enumeration date
06/28/2006
Last updated
02/21/2014
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