Provider Demographics
NPI:1639216864
Name:DONALD L.TUTT M.D. PC
Entity Type:Organization
Organization Name:DONALD L.TUTT M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-692-2118
Mailing Address - Street 1:PO BOX 19635
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73144-0635
Mailing Address - Country:US
Mailing Address - Phone:405-692-2118
Mailing Address - Fax:405-605-5816
Practice Address - Street 1:1016 SW 44TH ST
Practice Address - Street 2:STE 500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3616
Practice Address - Country:US
Practice Address - Phone:405-692-2118
Practice Address - Fax:405-605-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8459207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK507367753004OtherBCBS
OK507367753004OtherBCBS