Provider Demographics
NPI:1063459691
Name:NUTTING, CHARLES W (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:NUTTING
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 E CRESCENT PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2812
Mailing Address - Country:US
Mailing Address - Phone:303-241-0000
Mailing Address - Fax:303-479-6873
Practice Address - Street 1:8390 E CRESCENT PKWY STE 120
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2812
Practice Address - Country:US
Practice Address - Phone:303-241-0000
Practice Address - Fax:303-479-6873
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6632085R0202X
KS05-366372085R0202X
HIDOS15892085R0202X
MT1413982085R0204X
CODR.00399812085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200297040AMedicaid
MI114705326Medicaid
NM22257861Medicaid
NE10025709000Medicaid
WY1063459691Medicaid
NE84059792913Medicaid
IL036089378Medicaid
CO23721324Medicaid
NE84059792913Medicaid
KS111257024Medicare PIN
WY1063459691Medicaid
IL036089378Medicaid
CO390895ZLJ3Medicare PIN
COCO305756Medicare PIN
NE10025709000Medicaid
MI114705326Medicaid
COC547598Medicare PIN
COP00201572Medicare PIN
CO23721324Medicaid
NE84059792913Medicaid
NENA1215046Medicare PIN
COF75252Medicare UPIN