Healthcare Provider Details

I. General information

NPI: 1710980685
Provider Name (Legal Business Name): JOHN R SUTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 MIDDLE URBANA RD
SPRINGFIELD OH
45502-9285
US

IV. Provider business mailing address

3250 MIDDLE URBANA RD
SPRINGFIELD OH
45502-9285
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-7777
  • Fax: 937-399-6794
Mailing address:
  • Phone: 937-399-7777
  • Fax: 937-399-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-06-6614-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: