Provider Demographics
NPI:1861438822
Name:MUTTERPERL, ROBERT E (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MUTTERPERL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:
Practice Address - Street 1:6296 E GRANT RD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5876
Practice Address - Country:US
Practice Address - Phone:520-298-3321
Practice Address - Fax:888-978-2518
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0765360OtherBCBSAZ
AZ3369OtherAZ STATE MEDICAL LICENSE
AZ792417Medicaid
AZ410348Medicaid
AZ3369OtherAZ STATE MEDICAL LICENSE
AZ792417Medicaid