Provider Demographics
NPI:1407291412
Name:CARSON TAHOE ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:CARSON TAHOE ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-841-6333
Mailing Address - Street 1:1177 N DIVISION ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3874
Mailing Address - Country:US
Mailing Address - Phone:775-841-6333
Mailing Address - Fax:775-841-3304
Practice Address - Street 1:1177 N DIVISION ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3874
Practice Address - Country:US
Practice Address - Phone:775-841-6333
Practice Address - Fax:775-841-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1092207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty