Provider Demographics
NPI:1629010749
Name:TUTOR, DAVID KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KENT
Last Name:TUTOR
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 32569
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2569
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:1819 W CLINCH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2434
Practice Address - Country:US
Practice Address - Phone:865-524-5365
Practice Address - Fax:865-673-8007
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN020952208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF22969Medicare UPIN
TN0677340008Medicare NSC
TN0677340003Medicare NSC
TN000138944Medicare ID - Type UnspecifiedMEDICARE
TN0677340002Medicare NSC