Basic Information
| Provider Information | |||||||||
| NPI: | 1063459691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUTTING | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 PARK MEADOWS DRIVE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206688818 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8080 PARK MEADOWS DRIVE, SUITE 150 | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206688818 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 663 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 05-36637 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | DOS1589 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 39981 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 036089378 | 05 | IL | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 23721324 | 05 | CO | MEDICAID | 114705326 | 05 | MI | MEDICAID | 22257861 | 05 | NM | MEDICAID | 1063459691 | 05 | WY | MEDICAID | 200040130A | 05 | OK | MEDICAID | 200297040A | 05 | KS | MEDICAID | 84059792913 | 05 | NE | MEDICAID |