1003056037 NPI number — DR. FRITS SUTMOLLER M.D,

Table of content: DR. FRITS SUTMOLLER M.D, (NPI 1003056037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003056037 NPI number — DR. FRITS SUTMOLLER M.D,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTMOLLER
Provider First Name:
FRITS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003056037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RUA VISCONDE DE PIRAJA 414 ROOM 801
Provider Second Line Business Mailing Address:
IPANEMA
Provider Business Mailing Address City Name:
RIO DE JANEIRO
Provider Business Mailing Address State Name:
RJ
Provider Business Mailing Address Postal Code:
22410950
Provider Business Mailing Address Country Code:
BR
Provider Business Mailing Address Telephone Number:
552125212232
Provider Business Mailing Address Fax Number:
552122397932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RUA VISCONDE DE PIRAJA 414 ROOM 801
Provider Second Line Business Practice Location Address:
IPANEMA
Provider Business Practice Location Address City Name:
RIO DE JANEIRO
Provider Business Practice Location Address State Name:
RJ
Provider Business Practice Location Address Postal Code:
22410950
Provider Business Practice Location Address Country Code:
BR
Provider Business Practice Location Address Telephone Number:
552125212232
Provider Business Practice Location Address Fax Number:
552122397932
Provider Enumeration Date:
03/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  CRM 52331746 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 52331746 . This is a "CRM" identifier . This identifiers is of the category "OTHER".




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