Healthcare Provider Details

I. General information

NPI: 1407258783
Provider Name (Legal Business Name): JOSEPH A SUTTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S 336TH ST STE 500
FEDERAL WAY WA
98003-8300
US

IV. Provider business mailing address

9631 N NEVADA ST. SUITE 202
SPOKANE WA
99218-1197
US

V. Phone/Fax

Practice location:
  • Phone: 206-962-3535
  • Fax:
Mailing address:
  • Phone: 509-467-1100
  • Fax: 509-468-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60604531
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: