Provider Demographics
NPI:1477511939
Name:SUTTON, JEFFREY BLAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BLAINE
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:SUTIE 1A
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4612
Mailing Address - Country:US
Mailing Address - Phone:330-544-1500
Mailing Address - Fax:330-544-7988
Practice Address - Street 1:1250 YOUNGSTOWN WARREN RD
Practice Address - Street 2:SUTIE 1A
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4612
Practice Address - Country:US
Practice Address - Phone:330-544-1500
Practice Address - Fax:330-544-7988
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7547-S204D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2378323Medicaid
H76235Medicare UPIN
OH4098421Medicare ID - Type Unspecified