Provider Demographics
NPI:1356310783
Name:NUTTLI, THOMAS GERARD SR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GERARD
Last Name:NUTTLI
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4200 HOUMA BLVD
Mailing Address - Street 2:FL 3
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2970
Mailing Address - Country:US
Mailing Address - Phone:504-503-5205
Mailing Address - Fax:504-503-6019
Practice Address - Street 1:4200 HOUMA BLVD
Practice Address - Street 2:FL 3
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:504-503-5205
Practice Address - Fax:504-503-6019
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA017964207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1388114Medicaid
LAD98114Medicare UPIN
LA1388114Medicaid