Provider Demographics
NPI:1912094772
Name:TUTTLE, ALBERT RAY (PA)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:RAY
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:4600 S MILL AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6850
Mailing Address - Country:US
Mailing Address - Phone:928-348-2151
Mailing Address - Fax:928-428-3617
Practice Address - Street 1:1492 S. 20TH AVE.
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546
Practice Address - Country:US
Practice Address - Phone:928-348-2151
Practice Address - Fax:928-428-3617
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ66650Medicare ID - Type Unspecified
AZS49663Medicare UPIN