Organization
E. SUTPHEN MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC SUTPHEN MD (DELEGATED OFFICIAL)
(314) 525-1688
Entity
Organization
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1688
(314) 525-1689
Mailing address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1688
(314) 525-1689
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
R2P24
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507584704
—
MO
01
—
DC0795
RAILROAD MEDICARE
MO
Enumeration date
02/01/2006
Last updated
06/10/2009
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