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General NPI Number Information
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NPI Number | 1659355626
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Entity Type | Individual
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Provider Name | CAROL A SUTTON MD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 220 9TH ST
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City | PORT ST JOE
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State | FL
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Zip | 32456-1924
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Country | US
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Telephone | 850-229-8244
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Fax | 850-229-6003
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Provider Business Mailing Address
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Address Line | PO BOX 476 21890 NE CR 69A
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-0476
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Country | US
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Telephone | 850-674-4422
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Fax | 850-674-4422
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME 47545
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License Number State | FL
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