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General NPI Number Information
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NPI Number | 1356394837
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Entity Type | Individual
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Provider Name | MARK R. MCCUTCHEON MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 5100 RANGELINE SERVICE RD N TILLMAN'S CORNER
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City | MOBILE
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State | AL
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Zip | 36619-9504
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Country | US
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Telephone | 251-378-4000
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Fax | 251-378-4006
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Provider Business Mailing Address
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Address Line | 410 WEST CLINTON STREET
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City | JACKSON
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State | AL
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Zip | 36545-2623
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Country | US
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Telephone | 251-246-2350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11316
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License Number State | AL
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