Provider Demographics
NPI:1265465538
Name:JEFFREY L SUTTON
Entity Type:Organization
Organization Name:JEFFREY L SUTTON
Other - Org Name:HEART DISEASE SPECIALIST PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-309-4852
Mailing Address - Street 1:9742 VIA VERGA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6161
Mailing Address - Country:US
Mailing Address - Phone:561-309-4852
Mailing Address - Fax:561-304-0295
Practice Address - Street 1:9742 VIA VERGA ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6161
Practice Address - Country:US
Practice Address - Phone:561-309-4852
Practice Address - Fax:561-304-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 38277207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037029100Medicaid
FL08576Medicare ID - Type Unspecified
FL037029100Medicaid