Healthcare Provider Details

I. General information

NPI: 1003820135
Provider Name (Legal Business Name): GREGORY HOWARD TUTTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JAMES A TAYLOR CAMPUS HEALTH SERVIVE THE UNIVERSITY OF NORTH CAROLINA, CB#7470
CHAPEL HILL NC
27599-7470
US

IV. Provider business mailing address

201 INTERN WAY
DURHAM NC
27713-6054
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-6551
  • Fax: 919-966-0108
Mailing address:
  • Phone: 919-493-7046
  • Fax: 919-966-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberNC 23457
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: