Provider Demographics
NPI:1538114624
Name:TUTAR, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:TUTAR
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 1:300 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 5010
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3707
Mailing Address - Country:US
Mailing Address - Phone:904-823-8809
Mailing Address - Fax:904-823-8851
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 5010
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3707
Practice Address - Country:US
Practice Address - Phone:904-823-8809
Practice Address - Fax:904-823-8851
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85299207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264667600Medicaid
FL17062ZMedicare ID - Type Unspecified
FLH12358Medicare UPIN