Provider Demographics
NPI:1740270750
Name:SUTERA, PAUL T (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:SUTERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2917 CAMINO DEL RIO
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7824
Mailing Address - Country:US
Mailing Address - Phone:928-542-9103
Mailing Address - Fax:928-704-6067
Practice Address - Street 1:10225 S HARBOR AVE STE 5
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-9699
Practice Address - Country:US
Practice Address - Phone:928-361-9991
Practice Address - Fax:287-046-0679
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21975207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145773 001Medicaid
AZZ75945Medicare ID - Type Unspecified
AZ145773 001Medicaid