# JACOB TUTTLE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1023370053
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01072927A | IN | — |
| 207Q00000X | Family Medicine Physician | 11016632A | IN | — |
| 207Q00000X | Family Medicine Physician | 571891 | AZ | Yes |

## Other

- **Enumeration date:** 06/14/2012
- **Last updated:** 01/18/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201110130 | — | IN |
| 01 | — | M400075625 | MEDICARE PTAN | IN |