Provider Demographics
NPI:1891796462
Name:SUTPHIN, JOHN E JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:SUTPHIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:E
Other - Last Name:SUTPHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-6606
Mailing Address - Fax:913-588-0888
Practice Address - Street 1:7400 STATE LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3444
Practice Address - Country:US
Practice Address - Phone:913-588-6600
Practice Address - Fax:913-588-6655
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432154207WX0120X, 207W00000X
TXG2860207W00000X
IA29191207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2007407810AMedicaid
KSE97E868AOtherMEDICARE
IA12483OtherWELLMARCK BCBS
KS2007407810AMedicaid