Individual ProviderMitch TuttleRadiologyAllopathic & Osteopathic PhysiciansPractice Address3625 University Blvd S, Jacksonville, FL 32216-4207(904) 702-6111PECOS EnrollmentBased on the most recent information from CMS, provider Mitch Tuttle is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1710395314Provider TypeIndividualFull NameTuttle, MitchTitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date7/27/2014Last Updated4/3/2024Contact InformationPractice LocationPractice Address3625 University Blvd S, Jacksonville, FL 32216-4207Phone(904) 702-6111FaxUnlisted FaxMailing LocationMailing Address5767 W Century Blvd, Los Angeles, CA 90045-5631PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseME141405FloridaCode2085R0202XDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseA154101CaliforniaCode2085R0202XDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense2014014264Missouri