Provider Demographics
NPI:1689998676
Name:ROLAND O. DUTTON, M.D., INC.
Entity Type:Organization
Organization Name:ROLAND O. DUTTON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / ORTHOPAEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-273-9578
Mailing Address - Street 1:150 GLASSON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5706
Mailing Address - Country:US
Mailing Address - Phone:530-273-9578
Mailing Address - Fax:530-273-9570
Practice Address - Street 1:150 GLASSON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5706
Practice Address - Country:US
Practice Address - Phone:530-273-9578
Practice Address - Fax:530-273-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36765207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46793Medicare UPIN