Provider Demographics
NPI:1457323131
Name:SUTTER, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 E RENO AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7724
Mailing Address - Country:US
Mailing Address - Phone:405-737-8877
Mailing Address - Fax:405-737-4780
Practice Address - Street 1:8855 E RENO AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7724
Practice Address - Country:US
Practice Address - Phone:405-737-8877
Practice Address - Fax:405-737-4780
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18006207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK070015050OtherRAILROAD MEDICARE
OKF31822Medicare UPIN