Basic Information
| Provider Information | |||||||||
| NPI: | 1033735196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTTON | ||||||||
| FirstName: | CONNER | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652512511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736425911 | ||||||||
| FaxNumber: | 5736423015 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652512511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736425911 | ||||||||
| FaxNumber: | 5736423015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2020 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2020017745 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.