Provider Demographics
NPI:1043215635
Name:SUTTON, JAMES THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:SUTTON
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 1:588 STERTHAUS DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5128
Mailing Address - Country:US
Mailing Address - Phone:386-672-9503
Mailing Address - Fax:386-672-0386
Practice Address - Street 1:588 STERTHAUS DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5128
Practice Address - Country:US
Practice Address - Phone:386-672-9503
Practice Address - Fax:386-672-0386
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00441082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57714OtherUPIN
FL64518OtherBSBSFL
FL004179OtherFHCP
GT215AOtherMEDICARE-CMS
DT5266OtherRR MEDICARE GROUP
020007754OtherRR MEDICARE INDIVIDUAL