Healthcare Provider Details

I. General information

NPI: 1629020847
Provider Name (Legal Business Name): PAUL B NUTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE SE
PUYALLUP WA
98372-3715
US

IV. Provider business mailing address

401 15TH AVE SE
PUYALLUP WA
98372-3715
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-2700
  • Fax:
Mailing address:
  • Phone: 253-697-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD00021194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: