Provider Demographics
NPI:1033276225
Name:TUTTLE, FRED THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:THOMAS
Last Name:TUTTLE
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 1:4106 MASON WOODS LN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7552
Mailing Address - Country:US
Mailing Address - Phone:270-993-3999
Mailing Address - Fax:
Practice Address - Street 1:4106 MASON WOODS LN
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7552
Practice Address - Country:US
Practice Address - Phone:270-993-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080177443OtherRAILROAD MEDICARE
KY1155576OtherPASSPORT
KY2438914000OtherPASSPORT ADVANTAGE
000000206950OtherANTHEM BLUE CROSS
1001684OtherMETRACOMP
610901982OtherBLUEGRASS FAMILY HEALTH
KY64199110Medicaid
KY65917551OtherKENPAC
40582791500OtherCAREWORKS
1195470OtherCHA HEALTH
443632OtherAETNA
P00020977OtherRAILROAD RETIREMENT
010619500OtherBLACK LUNG
610901982OtherBENESIGHT
34346OtherUNITED HEALTHCARE
6109019820030OtherCIGNA
610901982EOtherHUMANA
610901982OtherCENTERCARE
610901982OtherCENTERCARE
KY2438914000OtherPASSPORT ADVANTAGE