Provider Demographics
NPI:1982665816
Name:STUTTS, WILLIAM (DO, PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:STUTTS
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4882 AUTUMN DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-7834
Mailing Address - Country:US
Mailing Address - Phone:319-743-3312
Mailing Address - Fax:319-743-3312
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-369-4777
Practice Address - Fax:319-369-4694
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA032532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAH10350Medicare UPIN
IAI12666Medicare ID - Type Unspecified