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General NPI Number Information
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NPI Number | 1285620955
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Entity Type | Organization
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Legal Business Name | STEPHEN P SUTTON MD INC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1050 ISAAC STREETS DR SUITE 126
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-698-2020
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Fax | 419-698-1520
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Provider Business Mailing Address
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Address Line | 1050 ISAAC STREETS DR SUITE 126
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-698-2020
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Fax | 419-698-1520
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN P SUTTON
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Credential | MD
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Telephone | 419-698-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35043749S
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License Number State | OH
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