Provider Demographics
NPI:1790776276
Name:SUTTON, JENNEFER CARL (MD)
Entity Type:Individual
Prefix:
First Name:JENNEFER
Middle Name:CARL
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13409 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3064
Mailing Address - Country:US
Mailing Address - Phone:210-492-8922
Mailing Address - Fax:
Practice Address - Street 1:1 IKEA RBFCU PKWY STE 3114
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-2792
Practice Address - Country:US
Practice Address - Phone:210-817-1370
Practice Address - Fax:210-479-2010
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341526702Medicaid
TX341526701Medicaid
TX341526703OtherCSHCN