Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 20226 | AZ |
NPI | 1114003183 |
---|---|
Provider Name | Michael Lewis Tutt |
First Address | Fort Defiance, AZ 86504-0649 |
Second Address | Fort Defiance, AZ 86504-0649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |