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General NPI Number Information
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NPI Number | 1891012811
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Entity Type | Organization
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Legal Business Name | JEFFREY TUTTLE, M.D., P.L.L.C.
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 219 E HIGH ST
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City | LEXINGTON
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State | KY
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Zip | 40507-1409
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Country | US
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Telephone | 859-537-7332
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Fax | 859-258-9209
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Provider Business Mailing Address
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Address Line | 219 E HIGH ST
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City | LEXINGTON
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State | KY
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Zip | 40507-1409
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Country | US
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Telephone | 859-537-7332
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Fax | 859-258-9209
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JEFFREY TUTTLE
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Credential | M.D.
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Telephone | 859-537-7332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 40860
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License Number State | KY
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