Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34-00-7547-S | OH |
Y | 207R00000X | Internist | 34-00-7547-S | OH |
Y | 111NI0900X | Internist | 34-00-7547-S | OH |
NPI | 1477511939 |
---|---|
Provider Name | Dr. Jeffrey Blaine Sutton |
First Address | Niles, OH 44446-4612 |
Second Address | Niles, OH 44446-4612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 18/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2378323 | (05) | OH |
H76235 | (02) |