Individual
REBECCA SUTPHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 2ND AVE NE STE 700, SAINT PETERSBURG, FL 33701-3441
(800) 975-4819
Mailing address
111 2ND AVE NE STE 700, ST PETERSBURG, FL 33701-3441
(800) 975-4819
Taxonomy
Speciality
Code
Description
License number
State
207SC0300X
Clinical Cytogenetics Physician
ME0061423
FL
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
ME0061423
FL
207SG0203X
Clinical Molecular Genetics Physician
ME0061423
FL
208000000X
Pediatrics Physician
ME61423
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250378600
—
FL
01
—
31447
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/30/2006
Last updated
12/12/2022
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