Provider Demographics
NPI:1376727412
Name:SHUTTE, BETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:SHUTTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:SENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:68 DARST RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3442
Mailing Address - Country:US
Mailing Address - Phone:937-531-0132
Mailing Address - Fax:937-531-0134
Practice Address - Street 1:68 DARST RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3442
Practice Address - Country:US
Practice Address - Phone:937-531-0132
Practice Address - Fax:937-531-0134
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3077870Medicaid
OH4301031Medicare PIN
OH3077870Medicaid
OHH259570Medicare PIN