1821070293 NPI number — RICHARD L NUTT JR. MD

Table of content: RICHARD L NUTT JR. MD (NPI 1821070293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821070293 NPI number — RICHARD L NUTT JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUTT
Provider First Name:
RICHARD
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
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:
1821070293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 2ND AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33770-3120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-581-8767
Provider Business Mailing Address Fax Number:
727-586-6018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W BAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-585-9500
Provider Business Practice Location Address Fax Number:
727-584-1938
Provider Enumeration Date:
11/18/2005

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: 207L00000X , with the licence number:  ME95431 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 53202 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0007307922 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 274989100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: U7288Y . This is a "MEDICARE GTBA REASSIGN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7118692 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00420506 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com