Individual
DR. MARK DAVID SURAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
12271 US HIGHWAY 301 N, PARRISH, FL 34219-8410
(941) 776-4050
(941) 776-4057
Mailing address
700 8TH AVE W, STE 101, PALMETTO, FL 34221-4737
(941) 776-4008
(941) 845-4963
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
07000627A
IN
213ES0131X
Foot Surgery Podiatrist
016-003659
IL
213ES0131X
Foot Surgery Podiatrist
Primary
PO1633
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003659
—
IL
01
—
0732240001
DMERC # WITH PPG
—
05
—
200899510
—
IN
01
—
60001608
BLUE CROSS PROVIDER ID
IL
Enumeration date
08/18/2005
Last updated
03/27/2017
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