Provider Demographics
NPI:1366231912
Name:JUTUT, UDAY TEJA
Entity type:Individual
Prefix:
First Name:UDAY
Middle Name:TEJA
Last Name:JUTUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLOWERS HOSPITAL
Mailing Address - Street 2:4370 WEST MAIN STREET
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:35306
Mailing Address - Country:US
Mailing Address - Phone:334-944-7090
Mailing Address - Fax:
Practice Address - Street 1:FLOWERS HOSPITAL
Practice Address - Street 2:4370 WEST MAIN STREET
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:35306
Practice Address - Country:US
Practice Address - Phone:334-944-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program