Individual
BRIAN EDWARD SUNDERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
67.000221
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085969
—
OH
Enumeration date
05/28/2013
Last updated
09/05/2013
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