Provider Demographics
NPI:1710973268
Name:NUTTER, DENVER D (MD)
Entity Type:Individual
Prefix:MR
First Name:DENVER
Middle Name:D
Last Name:NUTTER
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 1:6111 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2751
Mailing Address - Country:US
Mailing Address - Phone:904-739-1140
Mailing Address - Fax:904-722-9578
Practice Address - Street 1:6111 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2751
Practice Address - Country:US
Practice Address - Phone:904-739-1140
Practice Address - Fax:904-722-9578
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43493OtherBLUE CROSS BLUE SHIELD
FL1867789004OtherCIGNA
FL43493OtherBLUE CROSS BLUE SHIELD
FLF65735Medicare UPIN