DR. MARC TRAVIS NUTTALL (NPI# 1144497322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144497322 |
| Entity Type | Individual |
| Full Name | DR. MARC TRAVIS NUTTALL |
| Credential | MD |
| Practice Address |
1055 N 500 W Ste 202 Provo UT 84604-3305 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 8013742367 |
| Practice Fax Number | 8014298015 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2020-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 6805182-1205 | UT | Allopathic & Osteopathic Physicians |
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
68050182-1205 | UT | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1152 E 200 N, American Fork, UT 840032004 | 8013742367 | 8014298015 |
| Street Address |
1055 N 500 W STE 202 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699877316 | Steven F Larsen | Nurse Practitioner | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2006-09-02 |
| 1063975613 | Vanessa May Dexter | Registered Nurse | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2019-04-10 |
| 1790259968 | Michelle Ann Warren | Registered Nurse | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2019-01-21 |
| 1376052910 | Whitney Carpenter | Nurse Practitioner | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2017-09-27 |
| 1184099764 | Angela Chamberlain | Nurse Practitioner | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2015-12-07 |
| 1316330749 | Central Utah Clinic, P.C. | Non-Pharmacy Dispensing Site | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2015-03-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285929430 | Brandt L Esplin | Internal Medicine | 1055 N 500 W Ste 202, Bldg C, Provo, UT 84604-8460 | 2011-06-16 |
| 1699877308 | Brian P Tudor | Internal Medicine | 1055 N 500 W, Suite 202, Provo, UT 84604-3305 | 2006-09-02 |
| 1396778148 | Nathan Terry Rich | Internal Medicine | 1034 N 500 W, Provo, UT 84604-3380 | 2006-07-07 |
| 1790736122 | Steven L Wallentine | Internal Medicine | 1055 N 500 W, Suite 202, Provo, UT 84604-3305 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881123172 | Scott Marriner Browning | Internal Medicine | 2318 E Field Rose Dr, Salt Lake City, UT 84121-1500 | 2017-06-08 |
| 1356745137 | University of Utah Adult Services | Internal Medicine | 1950 E Circle of Hope Drive, Salt Lake City, UT 84112 | 2014-10-22 |
| 1982049227 | Bryan D Huber | Internal Medicine | 8th Avenue & C Street E8, Salt Lake City, UT 84143-3403 | 2013-04-30 |
| 1851631139 | Central Utah Clinic, P.C. | Internal Medicine | 2019 E Riverside Dr, Suite A200, St George, UT 84790-8134 | 2013-02-22 |
| 1457664005 | Sabarinath Venniyil Radhakrishna | Internal Medicine | 2000 Circle of Hope, Suite 2100, Huntsman Cancer Institute, Salt Lake City, UT 84112 | 2010-07-23 |
| 1427273705 | Utah Hematology Oncology PC | Internal Medicine | 4403 Harrison Blvd Ste 1685, Ogden, UT 84403-3274 | 2007-04-13 |
| 1225164114 | Finn Bo Petersen | Internal Medicine | E8 Lds Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143-0001 | 2007-02-26 |
| 1124172697 | Justin A Call | Internal Medicine | 3592 W 9000 S, Ste 200, West Jordan, UT 84088-8812 | 2007-01-22 |
| 1164524864 | Jay C Bott | Internal Medicine | 177 S 240 W, Orem, UT 84058-3052 | 2006-09-02 |
| 1417995911 | Wendy A Breyer | Internal Medicine | 5171 S Cottonwood St Ste 610, Murray, UT 84107-5704 | 2006-06-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.