MEDICARE: DR. GORDON BRUCE KUTTNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VE0102X	Reproductive Endocrinology Physician		NC

General Provider Information

NPI Number	:	1255337069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON BRUCE KUTTNER MD

Provider Business Mailing Address
First Line	:	10310 HOLLYBROOK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0509
Country	:	US
Telephone Number	:	704-847-9862
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 SPRINGBANK LN
Second Line	:	STE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3364
Country	:	US
Telephone Number	:	704-542-6006
Fax Number	:	704-542-0340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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