Organization
SWEETWATER UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL SUTPHIN MD (OWNER)
(307) 362-4200
Entity
Organization
Contact information
Practice address
1208 HILLTOP DR, SUITE 204, ROCK SPRINGS, WY 82901-5859
(307) 362-4200
(307) 362-5406
Mailing address
1208 HILLTOP DR, SUITE 204, ROCK SPRINGS, WY 82901-5859
(307) 362-4200
(307) 362-5406
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
166834-1025
UT
208800000X
Urology Physician
Primary
3547A
WY
208800000X
Urology Physician
G42452
CA
363A00000X
Physician Assistant
WY192
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104849000
—
WY
01
—
2266
BLUE CROSS OF WYOMING
WY
01
—
340001047
RAILROAD MEDICARE
WY
Enumeration date
09/09/2010
Last updated
09/09/2010
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