Provider Demographics
NPI:1942266374
Name:SUTKER, WILLIAM L (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:SUTKER
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 1:3409 WORTH ST
Mailing Address - Street 2:710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2029
Mailing Address - Country:US
Mailing Address - Phone:214-823-2533
Mailing Address - Fax:214-824-8679
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:710
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-823-2533
Practice Address - Fax:214-824-8679
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX440000050OtherRAIL ROAD MEDICARE
TXMDE5261OtherWORKERS COMP
TX4046840OtherAETNA
TX83M391OtherBLUE CROSS BLUE SHIELD
TXE5261OtherSTATE LICENSE
TX124502902Medicaid
TX2226817OtherBLUE LINK
TX440000050OtherRAIL ROAD MEDICARE
TX83M391Medicare ID - Type Unspecified