MEDICARE: DR. PHILLIP G SUTTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E2891	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083617914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP G SUTTON M.D.

Provider Business Mailing Address
First Line	:	17203 RED OAK DR
Second Line	:	SUITE 103
City	:	HOUSTON
State	:	TX
Zip	:	77090-2640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17203 RED OAK DR
Second Line	:	SUITE 103
City	:	HOUSTON
State	:	TX
Zip	:	77090-2612
Country	:	US
Telephone Number	:	281-893-2288
Fax Number	:	281-893-2882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/28/2010

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