Provider Demographics
NPI:1164646691
Name:SUTTON, SARA ESTHER (D O)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ESTHER
Last Name:SUTTON
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1304
Mailing Address - Country:US
Mailing Address - Phone:515-287-5883
Mailing Address - Fax:515-287-8687
Practice Address - Street 1:3219 SW 39TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-1304
Practice Address - Country:US
Practice Address - Phone:515-287-5883
Practice Address - Fax:515-287-8687
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IASO1170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA 00734Medicare UPIN