Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | C40784 | CA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | C40784 | CA |
NPI | 1598768277 |
---|---|
Provider Name | Dr. Donald J Clutter |
First Address | Sacramento, CA 95815-4314 |
Second Address | Folsom, CA 95630-3495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040007824 | RR MEDICARE PIN (01) | CA |
A37448 | (02) | CA |