Provider Demographics
NPI:1801807524
Name:TUTEN, HARRY LANE JR (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:LANE
Last Name:TUTEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:595 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-4735
Practice Address - Country:US
Practice Address - Phone:803-943-7600
Practice Address - Fax:803-943-7601
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.202439208600000X
SCMD16528208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14380OtherBCBS NC INDIV
NCP00350185OtherRAILROAD MEDICARE
NC5905475Medicaid
SCTL8202Medicaid
LA1316563Medicaid
NCP00350185OtherRAILROAD MEDICARE