Provider Demographics
NPI:1285679126
Name:ROBERT S CUTLER DO PA
Entity Type:Organization
Organization Name:ROBERT S CUTLER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:GRISSO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:561-842-5050
Mailing Address - Street 1:13005 SOUTHERN BLVD STE 122
Mailing Address - Street 2:MEDICAL MALL ONE, SUITE 122
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9231
Mailing Address - Country:US
Mailing Address - Phone:561-842-5050
Mailing Address - Fax:561-793-9989
Practice Address - Street 1:13005 SOUTHERN BLVD STE 122
Practice Address - Street 2:MEDICAL MALL ONE, SUITE 122
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9231
Practice Address - Country:US
Practice Address - Phone:561-842-5050
Practice Address - Fax:561-793-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5469208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80092BOtherBCBS
FLBD969Medicare PIN
FL80092BOtherBCBS
FLE12021Medicare UPIN