Provider Demographics
NPI:1770565970
Name:NEAL K SUTHERS MD DBA HUDSON-SUTHERS CLINIC
Entity type:Organization
Organization Name:NEAL K SUTHERS MD DBA HUDSON-SUTHERS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-735-2506
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:OK
Mailing Address - Zip Code:73834-0010
Mailing Address - Country:US
Mailing Address - Phone:580-735-2506
Mailing Address - Fax:580-735-2728
Practice Address - Street 1:1001 HWY 64 N
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:OK
Practice Address - Zip Code:73834-0010
Practice Address - Country:US
Practice Address - Phone:580-735-2506
Practice Address - Fax:580-735-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1207261QM2500X, 363AM0700X
OK9573208D00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty