Provider Demographics
NPI:1053366138
Name:SURRATT, WILSON FARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:FARRIS
Last Name:SURRATT
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 1:888 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3097
Mailing Address - Country:US
Mailing Address - Phone:808-522-4000
Mailing Address - Fax:
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3097
Practice Address - Country:US
Practice Address - Phone:808-522-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29664207L00000X
NC29964207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC050032554OtherRAILROAD MEDICARE
NC4597856OtherAETNA
NC81019OtherBCBSNC
SCN29964Medicaid
NC85330OtherMEDCOST
NC8981019Medicaid
NC0483397001OtherCIGNA
NC050032554OtherRAILROAD MEDICARE
SCN29964Medicaid