Provider Demographics
NPI:1699343376
Name:SUTTON, JEFFERSON CHARLES
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:CHARLES
Last Name:SUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 N SARA RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8576
Mailing Address - Country:US
Mailing Address - Phone:405-208-3160
Mailing Address - Fax:
Practice Address - Street 1:11120 N SARA RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8576
Practice Address - Country:US
Practice Address - Phone:405-208-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program