Healthcare Provider Details

I. General information

NPI: 1710395314
Provider Name (Legal Business Name): MITCH C TUTTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MITCH CHRISTOPHER TUTTLE MD

II. Dates (important events)

Enumeration Date: 07/27/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4207
US

IV. Provider business mailing address

5767 W CENTURY BLVD
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 904-702-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number83531
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME141405
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2014014264
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101278607
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA154101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: