Provider Demographics
NPI:1710987805
Name:CUTLER, BRETT (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:CUTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:BRETT
Other - Middle Name:
Other - Last Name:CUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM PA
Mailing Address - Street 1:105 SOUTHPARK BLVD
Mailing Address - Street 2:STE A103
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4162
Mailing Address - Country:US
Mailing Address - Phone:904-824-0869
Mailing Address - Fax:904-826-0966
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:STE A103
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4162
Practice Address - Country:US
Practice Address - Phone:904-824-0869
Practice Address - Fax:904-826-0966
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02940213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340202900Medicaid
FL65716OtherBCBS
FL4298427OtherAETNA
FL480033292Medicare PIN
U22018Medicare UPIN
FL4349830001Medicare NSC
FL4298427OtherAETNA