Healthcare Provider Details

I. General information

NPI: 1114964574
Provider Name (Legal Business Name): KENT SUTTERER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KENT STEVEN SUTTERER DO

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST CAPITOL DR
SAINT CHARLES MO
63301-2844
US

IV. Provider business mailing address

3817 INDIAN RIDGE LN
DEFIANCE MO
63341-2026
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5000
  • Fax:
Mailing address:
  • Phone: 417-483-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2002015981
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002015981
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: