1891790168 NPI number — DR. ROBERT P NUTTALL MD

Table of content: DR. ROBERT P NUTTALL MD (NPI 1891790168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891790168 NPI number — DR. ROBERT P NUTTALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUTTALL
Provider First Name:
ROBERT
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1891790168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000A SOUTHBRIDGE PKWY
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-7718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-871-4274
Provider Business Mailing Address Fax Number:
205-871-4301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 7TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-9665
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2005

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: 2085P0229X , with the licence number:  00014815 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104069 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-61184 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051516677 . This is a "BCBS AL (UAB)" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-16677 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00107083 . This is a "RAILROAD MEDICARE UAB" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630842160 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009927295 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103559 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-90119 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009925705 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009958825 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-20581 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009993575 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-17616 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-17618 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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