Provider Demographics
NPI:1194927640
Name:BRETT CUTLER DPM PA
Entity type:Organization
Organization Name:BRETT CUTLER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-824-0869
Mailing Address - Street 1:105 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE A103
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4162
Mailing Address - Country:US
Mailing Address - Phone:904-824-0869
Mailing Address - Fax:904-826-0966
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:SUITE A103
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4162
Practice Address - Country:US
Practice Address - Phone:904-824-0869
Practice Address - Fax:904-826-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2940213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21590OtherBLUE SHIELD
FL340202900Medicaid
FL4298427OtherAETNA
FL21590Medicare PIN
FL21590OtherBLUE SHIELD
FLU22018Medicare UPIN
FL340202900Medicaid