Individual
KENNETH ROGER SUSMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
510 CYPRESS ST, SUITE B, FORT BRAGG, CA 95437-5411
(707) 961-1972
(707) 961-1978
Mailing address
510 CYPRESS ST, SUITE B, FORT BRAGG, CA 95437-5411
(707) 961-1972
(707) 961-1978
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G679520
CA
Other
Enumeration date
01/09/2007
Last updated
07/08/2007
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