Provider Demographics
NPI:1982651311
Name:CUTLER, JONATHAN I (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:I
Last Name:CUTLER
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 1:2000 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9572
Mailing Address - Country:US
Mailing Address - Phone:641-472-4111
Mailing Address - Fax:
Practice Address - Street 1:5409 AVENUE O
Practice Address - Street 2:SUITE 118
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9601
Practice Address - Country:US
Practice Address - Phone:319-372-9292
Practice Address - Fax:319-372-3025
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24062207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
22226OtherIOWA HEALTH SOLUTIONS
IA41597OtherWELLMARK BLUE CROSS
IA0101OtherJOHN DEERE HEALTHCARE
IA1077800Medicaid
MO203412101Medicaid
IA41597Medicare ID - Type UnspecifiedMEDICARE
MO203412101Medicaid
A02363Medicare UPIN