Provider Demographics
NPI:1679577506
Name:SUTTER, LAWRENCE REMIGI (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:REMIGI
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 1:1429 COLLEGE AVE
Mailing Address - Street 2:STE C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4057
Mailing Address - Country:US
Mailing Address - Phone:209-524-9565
Mailing Address - Fax:209-524-1558
Practice Address - Street 1:1429 COLLEGE AVE
Practice Address - Street 2:STE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4057
Practice Address - Country:US
Practice Address - Phone:209-524-9565
Practice Address - Fax:209-524-1558
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG414042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679577506OtherNPI
A89727Medicare UPIN
00G414040Medicare ID - Type Unspecified