Provider Demographics
NPI:1366680134
Name:SUTTON, ROBERT CHARLES (CO,LO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHARLES
Last Name:SUTTON
Suffix:
Gender:M
Credentials:CO,LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-0920
Mailing Address - Country:US
Mailing Address - Phone:352-493-0360
Mailing Address - Fax:352-493-0369
Practice Address - Street 1:113 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0920
Practice Address - Country:US
Practice Address - Phone:352-493-0360
Practice Address - Fax:352-493-0369
Is Sole Proprietor?:No
Enumeration Date:2009-02-01
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT 92222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist