Provider Demographics
NPI:1063459691
Name:NUTTING, CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:NUTTING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 PARK MEADOWS DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:720-668-8818
Mailing Address - Fax:
Practice Address - Street 1:8080 PARK MEADOWS DRIVE, SUITE 150
Practice Address - Street 2:SUITE 150
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:720-668-8818
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6632085R0202X
KS05-366372085R0202X
HIDOS15892085R0202X
CO399812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089378Medicaid
NE10025709000Medicaid
CO23721324Medicaid
MI114705326Medicaid
NM22257861Medicaid
WY1063459691Medicaid
OK200040130AMedicaid
KS200297040AMedicaid
NE84059792913Medicaid
KS111257024Medicare PIN
WY1063459691Medicaid
IL036089378Medicaid
CO390895ZLJ3Medicare PIN
COCO305756Medicare PIN
NE10025709000Medicaid
MI114705326Medicaid
COC547598Medicare PIN
COP00201572Medicare PIN
CO23721324Medicaid
NE84059792913Medicaid
NENA1215046Medicare PIN
COF75252Medicare UPIN