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

Table of Contents

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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