Healthcare Provider Details

I. General information

NPI: 1508884255
Provider Name (Legal Business Name): ERIC MOORE CUTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WARDENBURG DRIVE UCB 119
BOULDER CO
80309-9346
US

IV. Provider business mailing address

1542 WHITE VIOLET WAY
LOUISVILLE CO
80027-2436
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-5101
  • Fax: 303-492-8222
Mailing address:
  • Phone: 717-887-6176
  • Fax: 303-492-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD068455L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA66161
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0055025
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0067206
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: