Provider Demographics
NPI:1124648696
Name:SUTPHEN, SEAN (DO)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:SUTPHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3136
Mailing Address - Country:US
Mailing Address - Phone:703-939-1207
Mailing Address - Fax:
Practice Address - Street 1:714 LINCOLN ST NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3311
Practice Address - Country:US
Practice Address - Phone:712-546-3677
Practice Address - Fax:712-546-3690
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine