Provider Demographics
NPI:1518053487
Name:CHRISTOPHER CUTTER MD INC A PROFESSIONAL MEDICAL CORPORTATION
Entity Type:Organization
Organization Name:CHRISTOPHER CUTTER MD INC A PROFESSIONAL MEDICAL CORPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:CUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-468-4038
Mailing Address - Street 1:704 POINCIANA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2208
Mailing Address - Country:US
Mailing Address - Phone:337-468-4038
Mailing Address - Fax:337-468-4042
Practice Address - Street 1:704 POINCIANA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2208
Practice Address - Country:US
Practice Address - Phone:337-468-4038
Practice Address - Fax:337-468-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15723R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1468509Medicaid
LA1538274287OtherNPI
LA5CNO4OtherMEDICARE PTAN NUMBER
LAA51847Medicare UPIN