Provider Demographics
NPI:1740311810
Name:SUTTON, STEVEN WAYNE (LP, CCP)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WAYNE
Last Name:SUTTON
Suffix:
Gender:M
Credentials:LP, CCP
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:#725
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2029
Mailing Address - Country:US
Mailing Address - Phone:214-824-2510
Mailing Address - Fax:214-826-0130
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:#725
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-824-2510
Practice Address - Fax:214-826-0130
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0082246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular