Provider Demographics
NPI:1528077781
Name:SUTTER, MARY F (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:SUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-442-5495
Mailing Address - Fax:866-812-1253
Practice Address - Street 1:51 S BRIAN MICKELSEN PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3610
Practice Address - Country:US
Practice Address - Phone:928-634-6828
Practice Address - Fax:928-639-8179
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77035Medicaid
AZ502915Medicaid
AZ502915Medicaid
NM300389Medicare PIN