Basic Information
| Provider Information | |||||||||
| NPI: | 1134625718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTTON | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | GLENN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 ERWIN ROAD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27710 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | KENANSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283498801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102960941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2018 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2022-02161 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.