Provider Demographics
NPI:1720688021
Name:CUTLER, EDWARD (CPCT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CUTLER
Suffix:
Gender:M
Credentials:CPCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5372
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-0054
Mailing Address - Country:US
Mailing Address - Phone:541-601-1319
Mailing Address - Fax:541-727-6640
Practice Address - Street 1:724 S CENTRAL AVE STE 206
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7833
Practice Address - Country:US
Practice Address - Phone:541-702-1923
Practice Address - Fax:541-727-6640
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38D2120916202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38D2120916OtherCLIA WAIVER CERT