Individual
JORDAN LEE DUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
203 N DIVISION ST, FLORA, IN 46929-1024
(574) 967-4523
(574) 967-4994
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01056529A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11319868
CAQH NUMBER
IN
05
—
200399760
—
IN
01
—
9397025
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
02/27/2025
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