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General NPI Number Information
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NPI Number | 1285995977
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Entity Type | Individual
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Provider Name | JACOB JOSIAH SUTTON D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 07/22/2018
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Provider Practice Location Address
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Address Line | 1011 HONOR HEIGHTS DR
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City | MUSKOGEE
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State | OK
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Zip | 74401
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Country | US
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Telephone | 918-577-3509
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Fax |
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Provider Business Mailing Address
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Address Line | 3613 S YORKTOWN PL
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City | TULSA
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State | OK
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Zip | 74105-3451
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Country | US
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Telephone | 918-706-1324
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Fax | 918-706-1324
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5446
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License Number State | OK
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