MEDICARE: PAUL T SUTERA 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	21975	AZ

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	:	1740270750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL T SUTERA M.D.

Provider Business Mailing Address
First Line	:	2917 CAMINO DEL RIO
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7824
Country	:	US
Telephone Number	:	928-542-9103
Fax Number	:	928-704-6067

Provider Business Practice Location Address
First Line	:	10225 S HARBOR AVE STE 5
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-9699
Country	:	US
Telephone Number	:	928-361-9991
Fax Number	:	287-046-0679

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	05/29/2024

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