MEDICARE: MICHAEL R MUTCHLER 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	207R00000X	Internal Medicine Physician	N1006	TX

General Provider Information

NPI Number	:	1679591267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R MUTCHLER MD

Provider Business Mailing Address
First Line	:	929 HILLTOP DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5845
Country	:	US
Telephone Number	:	817-596-7900
Fax Number	:	817-596-7901

Provider Business Practice Location Address
First Line	:	929 HILLTOP DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5845
Country	:	US
Telephone Number	:	817-596-7900
Fax Number	:	817-596-7901

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/10/2009

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