Healthcare Provider Details

I. General information

NPI: 1609980937
Provider Name (Legal Business Name): CRAIG S TUTTON MD, INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 MERRICK DR
ARDMORE OK
73401-1824
US

IV. Provider business mailing address

PO BOX 1466
ARDMORE OK
73402-1466
US

V. Phone/Fax

Practice location:
  • Phone: 580-224-0331
  • Fax: 580-224-0334
Mailing address:
  • Phone: 580-224-0331
  • Fax: 580-224-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20688
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100726670A/100053740
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name: MRS. SOUVANNAKAYSONE TUTTON
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 580-224-0331