Healthcare Provider Details

I. General information

NPI: 1194927640
Provider Name (Legal Business Name): BRETT CUTLER DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

105 SOUTHPARK BLVD SUITE 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 NumberPO 2940
License Number StateFL

VIII. Authorized Official

Name: DR. BRETT CUTLER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 904-824-0869