Provider Demographics
NPI:1942259148
Name:SUTTON, JEFFREY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:SUTTON
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 1:9742 VIA VERGA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6161
Mailing Address - Country:US
Mailing Address - Phone:561-969-0909
Mailing Address - Fax:561-304-0295
Practice Address - Street 1:9742 VIA VERGA ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6161
Practice Address - Country:US
Practice Address - Phone:561-304-0295
Practice Address - Fax:561-304-0295
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38277207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037029100Medicaid
FL08576Medicare ID - Type Unspecified