1164489662 NPI number — DR. RALPH EDWIN TUTTLE D.O.

Table of content: DR. RALPH EDWIN TUTTLE D.O. (NPI 1164489662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164489662 NPI number — DR. RALPH EDWIN TUTTLE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUTTLE
Provider First Name:
RALPH
Provider Middle Name:
EDWIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUTTLE
Provider Other First Name:
RALPH
Provider Other Middle Name:
EDWIN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164489662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 GREY MOSS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28443-3815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-979-6202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL MEDICAL CENTER CAMP LEJEUNE
Provider Second Line Business Practice Location Address:
100 BREWSTER BLVD
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-450-4145
Provider Business Practice Location Address Fax Number:
910-450-3762
Provider Enumeration Date:
04/27/2006

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: 2084P2900X , with the licence number:  02002839A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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