Provider Demographics
NPI:1568502979
Name:TUTTLE, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:DEPT LA 21613
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1613
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:800-409-7005
Practice Address - Street 1:2320 BATH STREET, SUITE 113
Practice Address - Street 2:
Practice Address - City:SANTA BRABARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4377
Practice Address - Country:US
Practice Address - Phone:805-682-7744
Practice Address - Fax:805-682-3321
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 1201722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568502979Medicaid
CA00A1201720OtherBS OF CA
CA1568502979Medicaid
CAGG287ZMedicare PIN
CAGG287XMedicare PIN