Provider Demographics
NPI:1467744557
Name:SUTTON, DANIEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:SUTTON
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 1:932 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4518
Mailing Address - Country:US
Mailing Address - Phone:480-786-9000
Mailing Address - Fax:480-786-5190
Practice Address - Street 1:932 W CHANDLER BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4518
Practice Address - Country:US
Practice Address - Phone:480-786-9000
Practice Address - Fax:480-786-5190
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ213582084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIMD21358Medicare Oscar/Certification
WIF67159Medicare UPIN