Healthcare Provider Details

I. General information

NPI: 1649203167
Provider Name (Legal Business Name): DR. PHILIP LEE DUTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 FLOWER STREET ROOM 1412
BAKERSFIELD CA
93305-4144
US

IV. Provider business mailing address

1830 FLOWER STREET ROOM 1412
BAKERSFIELD CA
93305-4144
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-326-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG80286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: