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General NPI Number Information
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NPI Number | 1124648696
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Entity Type | Individual
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Provider Name | SEAN SUTPHEN DO
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Gender | Male
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 714 LINCOLN ST NE
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City | LE MARS
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State | IA
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Zip | 51031-3311
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Country | US
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Telephone | 712-546-3677
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Fax | 712-546-3690
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Provider Business Mailing Address
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Address Line | 209 4TH AVE NW
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City | LE MARS
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State | IA
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Zip | 51031-3136
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Country | US
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Telephone | 703-939-1207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102207523
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License Number State | VA
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