Provider Demographics
NPI:1699934216
Name:MUTTER, JOSEPH BOYD (HAS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BOYD
Last Name:MUTTER
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 SW SAINT LUCIE WEST BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1709
Mailing Address - Country:US
Mailing Address - Phone:772-871-1222
Mailing Address - Fax:772-873-4999
Practice Address - Street 1:1420 SW SAINT LUCIE WEST BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1709
Practice Address - Country:US
Practice Address - Phone:772-871-1222
Practice Address - Fax:772-873-4999
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3398237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL610205100Medicaid