Provider Demographics
NPI:1003056037
Name:SUTMOLLER, FRITS (MD,)
Entity Type:Individual
Prefix:DR
First Name:FRITS
Middle Name:
Last Name:SUTMOLLER
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUA VISCONDE DE PIRAJA 414 ROOM 801
Mailing Address - Street 2:IPANEMA
Mailing Address - City:RIO DE JANEIRO
Mailing Address - State:RJ
Mailing Address - Zip Code:22410950
Mailing Address - Country:BR
Mailing Address - Phone:55212-521-2232
Mailing Address - Fax:55212-239-7932
Practice Address - Street 1:RUA VISCONDE DE PIRAJA 414 ROOM 801
Practice Address - Street 2:IPANEMA
Practice Address - City:RIO DE JANEIRO
Practice Address - State:RJ
Practice Address - Zip Code:22410950
Practice Address - Country:BR
Practice Address - Phone:55212-521-2232
Practice Address - Fax:55212-239-7932
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCRM 52331746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
52331746OtherCRM