Individual
DR. PHILLIP J SUFFRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 MEDICAL PARK DR, SUITE 300, BENTON, AR 72015-3728
(501) 778-1113
(501) 778-5391
Mailing address
3 MEDICAL PARK DR STE 300, BENTON, AR 72015-3726
(501) 778-1113
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
E2274
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06040018300
QUALCHOICE
AR
05
—
161592001
—
AR
01
—
204462170
UNITED HEALTHCARE
AR
01
—
5N525
BLUE CROSS BLUE SHIELD
AR
01
—
P00445226
RAILROAD MEDICARE
AR
Enumeration date
04/11/2006
Last updated
09/30/2013
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