Healthcare Provider Details

I. General information

NPI: 1871544858
Provider Name (Legal Business Name): FRED H CUTLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CASA LINDA PLZ
DALLAS TX
75218-3481
US

IV. Provider business mailing address

400 CASA LINDA PLAZA
DALLAS TX
75218-3415
US

V. Phone/Fax

Practice location:
  • Phone: 214-328-3501
  • Fax: 214-328-3502
Mailing address:
  • Phone: 214-328-3501
  • Fax: 214-328-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: