Provider Demographics
NPI:1407853062
Name:NUTTING, ROBERT O (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:O
Last Name:NUTTING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 THE STRAND
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4318
Mailing Address - Country:US
Mailing Address - Phone:310-545-0538
Mailing Address - Fax:310-546-4278
Practice Address - Street 1:1246 W 155TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4011
Practice Address - Country:US
Practice Address - Phone:310-768-2255
Practice Address - Fax:310-323-0914
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC24356208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK168AMedicare PIN
A88807Medicare UPIN