Provider Demographics
NPI:1427023233
Name:SUTTON, BETH H
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:H
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5620
Mailing Address - Country:US
Mailing Address - Phone:940-723-8465
Mailing Address - Fax:940-766-1965
Practice Address - Street 1:1600 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5620
Practice Address - Country:US
Practice Address - Phone:940-723-8465
Practice Address - Fax:940-766-1965
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5125208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC22416Medicare UPIN
TX00797UMedicare ID - Type Unspecified