Provider Demographics
NPI:1811989148
Name:MCNUTT, ROBERT ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:MCNUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:121 N LAST CHANCE GULCH
Mailing Address - Street 2:STE H
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4140
Mailing Address - Country:US
Mailing Address - Phone:406-422-4401
Mailing Address - Fax:406-422-4402
Practice Address - Street 1:121 N LAST CHANCE GULCH
Practice Address - Street 2:STE H
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4140
Practice Address - Country:US
Practice Address - Phone:406-422-4401
Practice Address - Fax:406-422-4402
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT11855207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24797Medicare UPIN
MTM011000721Medicare PIN