Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME0044108 | FL |
NPI | 1043215635 |
---|---|
Provider Name | James Thomas Sutton |
First Address | Ormond Beach, FL 32174-5128 |
Second Address | Ormond Beach, FL 32174-5128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 05/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004179 | FHCP (01) | FL |
020007754 | RR MEDICARE INDIVIDUAL (01) | |
64518 | BSBSFL (01) | FL |
D57714 | (02) | FL |
D57714 | UPIN (01) | |
DT5266 | RR MEDICARE GROUP (01) | |
GT215A | MEDICARE-CMS (01) |