Provider Demographics
NPI:1265453450
Name:TUTT, DONALD ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ERIC
Last Name:TUTT
Suffix:
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 1:4824 E BASELINE RD
Mailing Address - Street 2:STE 129
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4679
Mailing Address - Country:US
Mailing Address - Phone:480-644-1001
Mailing Address - Fax:480-644-1002
Practice Address - Street 1:4824 E BASELINE RD
Practice Address - Street 2:STE 129
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4679
Practice Address - Country:US
Practice Address - Phone:480-644-1001
Practice Address - Fax:480-644-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ272782Medicaid
AZDOO465Medicare UPIN
AZMD16197Medicare PIN