Healthcare Provider Details

I. General information

NPI: 1841253804
Provider Name (Legal Business Name): DOUGLAS M CUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W THUNDERBIRD BLVD HOSPITALIST OFFICE
SUN CITY AZ
85351-3004
US

IV. Provider business mailing address

PO BOX 11720
PRESCOTT AZ
86304-1720
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-5622
  • Fax:
Mailing address:
  • Phone: 928-771-5470
  • Fax: 928-771-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number27257
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27257
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: