Provider Demographics
NPI:1316909419
Name:SUERO, JAMES ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:SUERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 DELEWARE
Mailing Address - Street 2:SPECIALTIES CLINIC
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-414-2000
Mailing Address - Fax:
Practice Address - Street 1:1615 DELEWARE
Practice Address - Street 2:SPECIALTIES CLINIC
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-414-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032872207RC0000X, 207RI0011X
ORMD163521207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0280792OtherSTATE L&I
WA0280774OtherSTATE L&I
WA8371031Medicaid
WA0280791OtherSTATE L&I
WA8371031Medicaid
WAH18157Medicare UPIN
WAG8901284Medicare UPIN