Provider Demographics
NPI:1598261869
Name:TUTTLE DERMATOLOGY PC
Entity Type:Organization
Organization Name:TUTTLE DERMATOLOGY PC
Other - Org Name:DERMATOLOGY CLINIC OF SOUTHERN UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-218-7779
Mailing Address - Street 1:1173 S 250 W STE 301
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6753
Mailing Address - Country:US
Mailing Address - Phone:801-718-9148
Mailing Address - Fax:
Practice Address - Street 1:617 E RIVERSIDE DR STE 103
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8049
Practice Address - Country:US
Practice Address - Phone:352-187-7794
Practice Address - Fax:435-215-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8347280-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty