Provider Demographics
NPI:1417925165
Name:SUTTON, LARRY W (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0760
Mailing Address - Country:US
Mailing Address - Phone:812-254-7845
Mailing Address - Fax:812-254-5989
Practice Address - Street 1:1805 S SR 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4326
Practice Address - Country:US
Practice Address - Phone:812-254-7845
Practice Address - Fax:812-254-8857
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000751A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000094089OtherANTHEM
IN100175850Medicaid
IN000000094089OtherANTHEM
IN080098078OtherMEDICARE RAILROAD
IN000000094089OtherANTHEM
E33549Medicare UPIN