Individual
THOMAS PAUL MUTTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 S HAWTHORNE RD, SUITE 480, WINSTON SALEM, NC 27103-3913
(336) 765-0155
(336) 765-5494
Mailing address
1900 S HAWTHORNE RD, SUITE 480, WINSTON SALEM, NC 27103-3913
(336) 765-0155
(336) 765-5494
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
18688
NC
208600000X
Surgery Physician
Primary
18688
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122902
WELLPATH
—
01
—
125882
AETNA
—
01
—
1319922
CIGNA HEALTHCARE
—
01
—
2072030
FIRST HEALTH GROUP
—
01
—
28536
MEDCOST
—
01
—
546165
UHC
—
01
—
61648
BLUE CROSS/BLUESHIELD
—
05
—
8961648
—
NC
Enumeration date
08/02/2005
Last updated
10/25/2020
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