Provider Demographics
NPI:1114906435
Name:SUTTER, LORILEE SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LORILEE
Middle Name:SMITH
Last Name:SUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORILEE
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3037
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-3037
Mailing Address - Country:US
Mailing Address - Phone:209-605-5534
Mailing Address - Fax:760-416-6999
Practice Address - Street 1:275 N. EL CEILO RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6955
Practice Address - Country:US
Practice Address - Phone:760-320-8814
Practice Address - Fax:760-416-6999
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG411548207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114906435OtherNPI
00G415480Medicare ID - Type Unspecified
A48608Medicare UPIN