Healthcare Provider Details

I. General information

NPI: 1083744106
Provider Name (Legal Business Name): SCOTT DEAN CUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E. COTATI AVENUE
ROHNERT PARK CA
95404
US

IV. Provider business mailing address

1801 E. COTATI AVE.
ROHNERT PARK CA
95404
US

V. Phone/Fax

Practice location:
  • Phone: 707-664-2921
  • Fax: 707-664-2925
Mailing address:
  • Phone: 707-664-2921
  • Fax: 707-664-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG61595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: