Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME122802 | FL |
N | 207VX0000X | Obstetrician | ME122802 | FL |
NPI | 1437437019 |
---|---|
Provider Name | Dr. Jonathan Nutter |
First Address | St Petersburg, FL 33733-0549 |
Second Address | St Petersburg, FL 33712-2744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2011 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015214000 | (05) | FL |