MEDICARE: MARK R. MCCUTCHEON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11316	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C78586	OTHER	AL	UPIN

General Provider Information

NPI Number	:	1356394837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK R. MCCUTCHEON MD

Provider Business Mailing Address
First Line	:	410 WEST CLINTON STREET
Second Line	:
City	:	JACKSON
State	:	AL
Zip	:	36545-2623
Country	:	US
Telephone Number	:	251-246-2350
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 RANGELINE SERVICE RD N
Second Line	:	TILLMAN'S CORNER
City	:	MOBILE
State	:	AL
Zip	:	36619-9504
Country	:	US
Telephone Number	:	251-378-4000
Fax Number	:	251-378-4006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/10/2007

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