Healthcare Provider Details

I. General information

NPI: 1255337069
Provider Name (Legal Business Name): GORDON BRUCE KUTTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 SPRINGBANK LN STE 300
CHARLOTTE NC
28226-3364
US

IV. Provider business mailing address

10310 HOLLYBROOK DR
CHARLOTTE NC
28277-0509
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-6006
  • Fax: 704-542-0340
Mailing address:
  • Phone: 704-847-9862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: