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1821070293

NPI Code Detail

MEDICARE: RICHARD L NUTT JR. MD

MEDICARE: RICHARD L NUTT JR. 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	207L00000X	Anesthesiology Physician	ME95431	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	U7288Y	OTHER	FL	MEDICARE GTBA REASSIGN
6	P00420506	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53202	OTHER	FL	BCBS
2	0007307922	OTHER	FL	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7118692	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1821070293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD L NUTT JR. MD

Provider Business Mailing Address
First Line	:	1301 2ND AVE SW
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33770-3120
Country	:	US
Telephone Number	:	727-581-8767
Fax Number	:	727-586-6018

Provider Business Practice Location Address
First Line	:	1401 W BAY DR
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33770-2207
Country	:	US
Telephone Number	:	727-585-9500
Fax Number	:	727-584-1938

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	01/06/2014

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Directions to “ RICHARD L NUTT JR. MD” Practice Location

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