MEDICARE: DR. ROGER HEADLY TUTTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	0101055481	VA
2	2085R0202X	Diagnostic Radiology Physician	6414E	PA
3	2085R0202X	Diagnostic Radiology Physician	R2215	LA

General Provider Information

NPI Number	:	1023088606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER HEADLY TUTTON M.D.

Provider Business Mailing Address
First Line	:	1839 MONUMENT AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-2801
Country	:	US
Telephone Number	:	804-355-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1839 MONUMENT AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-2801
Country	:	US
Telephone Number	:	804-355-7788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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