Provider Demographics
NPI:1548262330
Name:JUTTON, JERRILYN M (MD)
Entity type:Individual
Prefix:DR
First Name:JERRILYN
Middle Name:M
Last Name:JUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 LUBRANO DR
Mailing Address - Street 2:SUITE L-101
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7564
Mailing Address - Country:US
Mailing Address - Phone:410-224-7449
Mailing Address - Fax:410-626-1698
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:877-866-7123
Practice Address - Fax:855-855-2792
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38829208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
354900OtherMAMSI
3962433OtherBCBS
5484285OtherAETNA PPO
0001OtherBCBS
609963600OtherFEDERAL WORKMAN'S COMP
42543903OtherBCBS
224963OtherKAISER
224963OtherKAISER
42543903OtherBCBS
129NL591Medicare PIN