Provider Demographics
NPI:1295767697
Name:CHUTINAN, T TERRY (MD)
Entity type:Individual
Prefix:DR
First Name:T
Middle Name:TERRY
Last Name:CHUTINAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 N STATE ROAD 434
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7041
Mailing Address - Country:US
Mailing Address - Phone:407-862-4242
Mailing Address - Fax:407-862-9616
Practice Address - Street 1:800 N STATE ROAD 434
Practice Address - Street 2:SUITE 4
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7041
Practice Address - Country:US
Practice Address - Phone:407-862-4242
Practice Address - Fax:407-862-9616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23398208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48736OtherBCBS
FL051371700Medicaid
FL48736ZMedicare PIN
FL48736OtherBCBS