Provider Demographics
NPI:1720305642
Name:MCNUTT, STEPHEN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANDREW
Last Name:MCNUTT
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:PO BOX 451496
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0036
Mailing Address - Country:US
Mailing Address - Phone:443-695-3856
Mailing Address - Fax:
Practice Address - Street 1:1710 E SAUNDERS ST STE B675
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5456
Practice Address - Country:US
Practice Address - Phone:956-401-6615
Practice Address - Fax:956-724-3613
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123366207W00000X
TXQ7580207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty