Provider Demographics
NPI:1669646535
Name:PHILLIP G SUTTON MD PA
Entity Type:Organization
Organization Name:PHILLIP G SUTTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-893-2288
Mailing Address - Street 1:17203 RED OAK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2640
Mailing Address - Country:US
Mailing Address - Phone:281-893-2288
Mailing Address - Fax:281-893-2882
Practice Address - Street 1:17203 RED OAK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2640
Practice Address - Country:US
Practice Address - Phone:281-893-2288
Practice Address - Fax:281-893-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2891208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031953501Medicaid
TX00AR87Medicare PIN
TXC22415Medicare UPIN