Healthcare Provider Details

I. General information

NPI: 1164489662
Provider Name (Legal Business Name): RALPH EDWIN TUTTLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. RALPH EDWIN TUTTLE

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/10/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER CAMP LEJEUNE 100 BREWSTER BLVD
CAMP LEJEUNE NC
28547
US

IV. Provider business mailing address

100 GREY MOSS CT
HAMPSTEAD NC
28443-3815
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4145
  • Fax: 910-450-3762
Mailing address:
  • Phone: 360-979-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number02002839A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: