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General NPI Number Information
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NPI Number | 1710395314
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Entity Type | Individual
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Provider Name | MITCH C TUTTLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2014
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 3625 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4207
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Country | US
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Telephone | 904-702-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 83531
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME141405
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2014014264
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101278607
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A154101
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License Number State | CA
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