Provider Demographics
NPI:1730478298
Name:UTT, JAMES RUSSELL (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:UTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-0368
Mailing Address - Country:US
Mailing Address - Phone:918-343-8574
Mailing Address - Fax:918-343-8575
Practice Address - Street 1:1501 N FLORENCE AVE
Practice Address - Street 2:STE 350
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3179
Practice Address - Country:US
Practice Address - Phone:918-343-8574
Practice Address - Fax:918-343-8575
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant