Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD-060731-L | PA |
N | 208600000X | Surgeon | MD-060731-L | PA |
Y | 2086S0129X | Vascular Surgeon | MD-060731-L | PA |
NPI | 1174594683 |
---|---|
Provider Name | Dr. John Anthony Kutz |
First Address | Scranton, PA 18510-1639 |
Second Address | Scranton, PA 18510-1639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019552360001 | (05) | PA |
H85982 | (02) | PA |