Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 14353 | NE |
NPI | 1023016656 |
---|---|
Provider Name | Gregory E Sutton |
First Address | Lincoln, NE 68506-1676 |
Second Address | Lincoln, NE 68506-1676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 01/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025619700 | (05) | NE |
100367060A | (05) | KS |
1231 | BLUE SHIELD (01) | NE |
D17264 | (02) |