Provider Demographics
NPI:1427044395
Name:CLOUTIER, CHARLES GARRISON (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GARRISON
Last Name:CLOUTIER
Suffix:
Gender:M
Credentials:MD
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 681944
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36068-1944
Mailing Address - Country:US
Mailing Address - Phone:334-351-2040
Mailing Address - Fax:334-351-2047
Practice Address - Street 1:461 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3409
Practice Address - Country:US
Practice Address - Phone:334-351-2040
Practice Address - Fax:334-351-2047
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51013871OtherBLUE CROSS BLUE SHIELD
AL011084OtherUNITED HEALTHCARE
AL009952895Medicaid