Healthcare Provider Details

I. General information

NPI: 1710987805
Provider Name (Legal Business Name): BRETT CUTLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRETT CUTLER DPM PA

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SOUTHPARK BLVD STE A103
ST AUGUSTINE FL
32086-4162
US

IV. Provider business mailing address

105 SOUTHPARK BLVD STE A103
ST AUGUSTINE FL
32086-4162
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-0869
  • Fax: 904-826-0966
Mailing address:
  • Phone: 904-824-0869
  • Fax: 904-826-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP02940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: