Basic Information
| Provider Information | |||||||||
| NPI: | 1801807524 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TUTEN | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | LANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655727 | ||||||||
| FaxNumber: | 2257659196 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 W CAROLINA AVE | ||||||||
| Address2: | |||||||||
| City: | VARNVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299444735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039437600 | ||||||||
| FaxNumber: | 8039437601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD.202439 | LA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD16528 | SC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 14380 | 01 | NC | BCBS NC INDIV | OTHER | P00350185 | 01 | NC | RAILROAD MEDICARE | OTHER | 5905475 | 05 | NC | MEDICAID | TL8202 | 05 | SC | MEDICAID | 1316563 | 05 | LA | MEDICAID |