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General NPI Number Information
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NPI Number | 1891914602
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Entity Type | Organization
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Legal Business Name | ROGER W. NUTT, M.D.,P.C.
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 710 S 13TH ST SUITE 1200
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City | NORFOLK
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State | NE
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Zip | 68701-5792
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Country | US
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Telephone | 402-370-4570
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Fax |
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Provider Business Mailing Address
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Address Line | 710 S 13TH ST SUITE 1200
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City | NORFOLK
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State | NE
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Zip | 68701-5792
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Country | US
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Telephone | 402-370-4570
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER WAYNE NUTT
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Credential | M.D.
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Telephone | 928-344-4907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 15072
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License Number State | AZ
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