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General NPI Number Information
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NPI Number | 1609980937
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Entity Type | Organization
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Legal Business Name | CRAIG S TUTTON MD, INC PC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1212 MERRICK DR
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City | ARDMORE
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State | OK
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Zip | 73401-1824
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Country | US
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Telephone | 580-224-0331
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Fax | 580-224-0334
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Provider Business Mailing Address
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Address Line | PO BOX 1466
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City | ARDMORE
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State | OK
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Zip | 73402-1466
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Country | US
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Telephone | 580-224-0331
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Fax | 580-224-0334
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SOUVANNAKAYSONE TUTTON
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Credential | RN
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Telephone | 580-224-0331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 20688
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License Number State | OK
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Legacy Identifiers
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Identifier #1
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Identifier Code | 100726670A/100053740
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Identifier Type | MEDICAID
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Identifier State | OK
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 100726670A/100053740
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Identifier Type | MEDICAID
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Identifier State | OK
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Identifier Issuer |
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