Provider Demographics
NPI:1205844370
Name:KUTCHBACK, JAMES WILLIAM (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:KUTCHBACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 N SUMMER CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6224
Mailing Address - Country:US
Mailing Address - Phone:936-273-7831
Mailing Address - Fax:936-273-7831
Practice Address - Street 1:17191 ST LUKES WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8042
Practice Address - Country:US
Practice Address - Phone:936-273-3311
Practice Address - Fax:936-273-3368
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1755213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180070801Medicaid
TXU07016Medicare UPIN
GAP00448635Medicare PIN
TX8K0509Medicare PIN