Provider Demographics
NPI:1801022009
Name:MUTCH, ELIZABETH MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:MUTCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 WENDAM CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9331
Mailing Address - Country:US
Mailing Address - Phone:386-767-0669
Mailing Address - Fax:386-767-0669
Practice Address - Street 1:986 WENDAM CT
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9331
Practice Address - Country:US
Practice Address - Phone:386-767-0669
Practice Address - Fax:386-767-0669
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42969208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice