| Doctor Name: | MR. ROBERT PAUL NUTTER |
| NPI Number: | 1043295199 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | |
| Business Practice Address: | 11050 Mount Belvedere Blvd Usa Meddac/credentials Fort Drum, NY - 136025438 |
| Business Phone Number: | 3157724025 |
| Business Fax Number: | 3157729498 |
| Mailing Address: | 11050 Mount Belvedere Blvd, Usa Meddac Attn: Credentials FORT DRUM |
| State: | NY |
| Postal Code: | 136025438 |
| Phone Number: | 3157724025 |
| Fax Number: | 3157729498 |
| NPI Enumeration Date: | 12/13/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |