Provider Demographics
NPI:1083617914
Name:SUTTON, PHILLIP G (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:G
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 1:17203 RED OAK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17203 RED OAK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2612
Practice Address - Country:US
Practice Address - Phone:281-893-2288
Practice Address - Fax:281-893-2882
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031953501Medicaid
TXC22415Medicare UPIN
TX00AR87Medicare PIN