Healthcare Provider Details

I. General information

NPI: 1457472961
Provider Name (Legal Business Name): NATHAN BENJAMIN SAUTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LILLY RD NE STE 202
OLYMPIA WA
98506-7400
US

IV. Provider business mailing address

128 LILLY RD NE STE 202
OLYMPIA WA
98506-7400
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-6314
  • Fax: 360-705-3745
Mailing address:
  • Phone: 360-357-6314
  • Fax: 360-705-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD60773432
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD27299
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: