Provider Demographics
NPI:1609980937
Name:CRAIG S TUTTON MD, INC PC
Entity Type:Organization
Organization Name:CRAIG S TUTTON MD, INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOUVANNAKAYSONE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-224-0331
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-1466
Mailing Address - Country:US
Mailing Address - Phone:580-224-0331
Mailing Address - Fax:580-224-0334
Practice Address - Street 1:1212 MERRICK DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1824
Practice Address - Country:US
Practice Address - Phone:580-224-0331
Practice Address - Fax:580-224-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK206882084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100726670A/100053740Medicaid
OK100726670A/100053740Medicaid
G25135Medicare UPIN