Healthcare Provider Details

I. General information

NPI: 1043267008
Provider Name (Legal Business Name): RICHARD F. KUTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/11/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14426 JAMES BOND RD
GULFPORT MS
39503-8311
US

IV. Provider business mailing address

14426 JAMES BOND RD
GULFPORT MS
39503-8311
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-7353
  • Fax: 228-328-6015
Mailing address:
  • Phone: 985-781-7353
  • Fax: 228-328-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number021881
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: