Individual
JACOB TUTTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 W BETHANY HOME RD # 200, PHOENIX, AZ 85015
(602) 246-5526
(602) 433-6686
Mailing address
2000 W BETHANY HOME RD # 200, PHOENIX, AZ 85015-2443
(602) 246-5525
(602) 433-6686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01072927A
IN
207Q00000X
Family Medicine Physician
11016632A
IN
207Q00000X
Family Medicine Physician
Primary
571891
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201110130
—
IN
01
—
M400075625
MEDICARE PTAN
IN
Enumeration date
06/14/2012
Last updated
01/18/2020
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