Healthcare Provider Details

I. General information

NPI: 1609132810
Provider Name (Legal Business Name): ERIN PAMELA SUTTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 NW FAIRWAY HEIGHTS DR
BEND OR
97703
US

IV. Provider business mailing address

3247 NW FAIRWAY HEIGHTS DR
BEND OR
97703-5491
US

V. Phone/Fax

Practice location:
  • Phone: 347-486-2707
  • Fax: 541-227-2354
Mailing address:
  • Phone: 347-486-2707
  • Fax: 541-227-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2017-01760
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD187709
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2017-01760
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: