Provider Demographics
NPI:1255368676
Name:SUTTON, JEFFREY J (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
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 1:2710 SAINT FRANCIS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5664
Mailing Address - Country:US
Mailing Address - Phone:319-272-8065
Mailing Address - Fax:
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 111
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5664
Practice Address - Country:US
Practice Address - Phone:319-272-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0179549Medicaid
IA0179549Medicaid
IA46854Medicare PIN