Mcnutt, Charlton Bryan

Mcnutt, Charlton Bryan is an individual health care provider with primary practice located at 150 Kenneth Ford Drive , Roseburg OR 97470-1042. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Mcnutt, Charlton Bryan can be contacted via phone (541) 672-9596.

Contact Information

Primary practice address
150 Kenneth Ford Drive Roseburg OR 97470-1042
Phone: (541) 672-9596
Fax: (541) 464-3519
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 38225N3 Oregon

Profile Details

NPI number 1144293648
LBN Legal business name Mcnutt, Charlton Bryan
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2006
Last updated Sep 10th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144293648 NPPES
Oregon MEDICAID 168395
Oregon Other R103163

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