Individual
DR. MARC TRAVIS NUTTALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W STE 202, PROVO, UT 84604-3305
(801) 374-2367
(801) 429-8015
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
6805182-1205
UT
207RH0003X
Hematology & Oncology Physician
Primary
68050182-1205
UT
Other
Enumeration date
05/15/2008
Last updated
08/19/2021
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