Provider Demographics
NPI:1659355626
Name:SUTTON, CAROL A (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:21890 NE CR 69A
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-0476
Mailing Address - Country:US
Mailing Address - Phone:850-674-4422
Mailing Address - Fax:850-674-4422
Practice Address - Street 1:220 9TH ST
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1924
Practice Address - Country:US
Practice Address - Phone:850-229-8244
Practice Address - Fax:850-229-6003
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 47545208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044054004Medicaid
FL02905WMedicare PIN
FLD60924Medicare UPIN
FLP00322674Medicare PIN