Provider Demographics
NPI:1396008306
Name:TUTEN, NEILL RYAN (MD)
Entity Type:Individual
Prefix:
First Name:NEILL
Middle Name:RYAN
Last Name:TUTEN
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:PO BOX 9156
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9156
Mailing Address - Country:US
Mailing Address - Phone:304-598-4000
Mailing Address - Fax:304-293-2245
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-1964
Practice Address - Fax:304-293-7126
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL34918207R00000X
WV26561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine