Provider Demographics
NPI:1003898883
Name:MCNUTT, JAMES TREVOR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TREVOR
Last Name:MCNUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-321-0700
Mailing Address - Fax:303-321-0811
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-321-0700
Practice Address - Fax:303-321-0811
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO391062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH72875Medicare UPIN
CO802495Medicare ID - Type UnspecifiedINDIVIDUAL
CO802496Medicare ID - Type UnspecifiedGROUP