Provider Demographics
NPI:1447247507
Name:DR.SUTTER & DR.PHAN
Entity type:Organization
Organization Name:DR.SUTTER & DR.PHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.SUTTER MD.
Authorized Official - Prefix:DR
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:WONG
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-725-4212
Mailing Address - Street 1:PO BOX 6610
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-6610
Mailing Address - Country:US
Mailing Address - Phone:806-796-0507
Mailing Address - Fax:806-799-6908
Practice Address - Street 1:3615 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-4212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-3529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QK15/00Q16Medicare ID - Type Unspecified
TXE80966Medicare UPIN