Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 106 | AK |
N | 204E00000X | Oral & Maxillofacial Surgeon | 9881 | KY |
NPI | 1124030085 |
---|---|
Provider Name | Stephen H Sutley |
First Address | Fairbanks, AK 99701-3171 |
Second Address | Fairbanks, AK 99701-3171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BS4634968 | DEA (01) | AK |
DD441 | (05) | AK |
U58591 | (02) | AK |