Provider Demographics
NPI:1912934928
Name:NUTIS, DINORAH JANET (MD)
Entity Type:Individual
Prefix:
First Name:DINORAH
Middle Name:JANET
Last Name:NUTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1171 LARRY MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6509
Mailing Address - Country:US
Mailing Address - Phone:915-532-1197
Mailing Address - Fax:915-532-1198
Practice Address - Street 1:1171 LARRY MAHAN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6509
Practice Address - Country:US
Practice Address - Phone:915-532-1197
Practice Address - Fax:915-532-1198
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H0704OtherBCBS OF TEXAS
TX161145101Medicaid
TX8H0704OtherBCBS OF TEXAS
TX161145101Medicaid