Provider Demographics
NPI:1992702609
Name:SUTTON, JAMES R (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:SUTTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5300
Mailing Address - Country:US
Mailing Address - Phone:513-421-3494
Mailing Address - Fax:513-867-3241
Practice Address - Street 1:2960 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5300
Practice Address - Country:US
Practice Address - Phone:513-421-3494
Practice Address - Fax:513-867-3241
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-2237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSUPA23901Medicare ID - Type Unspecified1416 W. FIRST STREET
OHSUPA23902Medicare ID - Type Unspecified9000 N. MAIN ST/STE 202