Individual
ERIC SUTPHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
450 N NEW BALLAS RD STE 70W, SAINT LOUIS, MO 63141-6833
(314) 227-2301
(314) 227-2316
Mailing address
215 DUNN RD, FLORISSANT, MO 63031-7928
(314) 315-9913
(314) 872-8069
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
R2P24
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203032628
—
MO
01
—
P00146606
RAILROAD MEDICARE
MO
Enumeration date
01/30/2006
Last updated
01/16/2015
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