Provider Demographics
NPI:1760526974
Name:TUTTLE, JOHN CLOYD SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLOYD
Last Name:TUTTLE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:230 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-4329
Mailing Address - Country:US
Mailing Address - Phone:704-932-7016
Mailing Address - Fax:704-932-7369
Practice Address - Street 1:230 OAK AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4329
Practice Address - Country:US
Practice Address - Phone:704-932-7016
Practice Address - Fax:704-932-7369
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC28704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC84193OtherBC-BS
NC8984193Medicaid
NC203876AMedicare PIN
NCC82130Medicare UPIN