Provider Demographics
NPI:1174542583
Name:SUTTON, REBECCA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JANE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:STE 419-A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2303
Mailing Address - Country:US
Mailing Address - Phone:816-795-1647
Mailing Address - Fax:816-795-8171
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:STE 419-A
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-795-1647
Practice Address - Fax:816-795-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34205207R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH69011Medicare UPIN