Provider Demographics
NPI:1821070293
Name:NUTT, RICHARD L JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:NUTT
Suffix:JR
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 1:1301 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3120
Mailing Address - Country:US
Mailing Address - Phone:727-581-8767
Mailing Address - Fax:727-586-6018
Practice Address - Street 1:1401 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2207
Practice Address - Country:US
Practice Address - Phone:727-585-9500
Practice Address - Fax:727-584-1938
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95431207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53202OtherBCBS
FL0007307922OtherAETNA
FL274989100Medicaid
FLU7288YOtherMEDICARE GTBA REASSIGN
FL7118692OtherCIGNA
FLP00420506OtherMEDICARE RAILROAD
D42245Medicare UPIN
FLU7288YOtherMEDICARE GTBA REASSIGN
FL274989100Medicaid