Provider Demographics
NPI:1336280254
Name:DR. MARK MCCUTCHEON, P.A.
Entity Type:Organization
Organization Name:DR. MARK MCCUTCHEON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-733-3420
Mailing Address - Street 1:660 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7000
Mailing Address - Country:US
Mailing Address - Phone:727-733-3420
Mailing Address - Fax:727-734-1641
Practice Address - Street 1:660 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7000
Practice Address - Country:US
Practice Address - Phone:727-733-3420
Practice Address - Fax:727-734-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 2454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6903Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER