Basic Information
| Provider Information | |||||||||
| NPI: | 1326286915 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT E MUTTERPERL DO SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6296 E GRANT RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202983321 | ||||||||
| FaxNumber: | 8889782518 | ||||||||
| Practice Location | |||||||||
| Address1: | 6296 E GRANT RD STE 104 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2029833215 | ||||||||
| FaxNumber: | 8889782518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2009 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | MUTTERPERL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5202983321 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 3369 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 410348 | 05 | AZ | MEDICAID |