Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 7275 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7275 | KY |
NPI | 1316916463 |
---|---|
Provider Name | Dr. James Michael Sutton |
First Address | Bowling Green, KY 42104-3348 |
Second Address | Bowling Green, KY 42104-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100070660 | (05) | KY |
710009086 | (05) | KY |