Provider Demographics
NPI:1891790168
Name:NUTTALL, ROBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:NUTTALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000148152085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL104069Medicaid
AL511-61184OtherBLUE CROSS
AL051516677OtherBCBS AL (UAB)
AL515-16677OtherBLUE CROSS
ALP00107083OtherRAILROAD MEDICARE UAB
AL630842160OtherAETNA
AL009927295Medicaid
AL103559Medicaid
AL515-90119OtherBLUE CROSS
AL009925705Medicaid
AL009958825Medicaid
AL515-20581OtherBLUE CROSS
AL009993575Medicaid
AL515-17616OtherBLUE CROSS
AL515-17618OtherBLUE CROSS
AL630842160OtherAETNA
AL009927295Medicaid