=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114902517
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT NEIL SUTER D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2005
-----------------------------------------------------
Last Update Date | 04/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 CLARA BARTON BLVD SUITE 340
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75042-5738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-800-2260
-----------------------------------------------------
Fax | 469-800-2270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 CLARA BARTON BLVD SUITE 340
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75042-5738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-800-2260
-----------------------------------------------------
Fax | 469-800-2270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L5578
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | L5578
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------