Individual
MR. PATRICK RUSSELL TUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1455 BATTERSBY AVE, ENUMCLAW, WA 98022-3634
(253) 426-6341
(253) 426-6344
Mailing address
1455 BATTERSBY AVE, ENUMCLAW, WA 98022-3634
(253) 426-6341
(253) 426-6344
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60797427
WA
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA60797427
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2108963
—
WA
Enumeration date
09/08/2017
Last updated
09/09/2021
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