Provider Demographics
NPI:1871680827
Name:NUTT, JOHN GORDON (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GORDON
Last Name:NUTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 SW SAM JACKLSON PARK ROAD
Mailing Address - Street 2:OREGON HEALTH & SCIENCE UNIVERSITY, DEPARTMENT OF NEURO
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1558
Mailing Address - Country:US
Mailing Address - Phone:503-494-7228
Mailing Address - Fax:503-494-9059
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:OREGON HEALTH & SCIENCE UNIVERSITY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-7772
Practice Address - Fax:503-494-9059
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2011-09-08
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Provider Licenses
StateLicense IDTaxonomies
ORMD115842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247452Medicaid
C93422Medicare UPIN