Provider Demographics
NPI:1356394837
Name:MCCUTCHEON, MARK R (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:MCCUTCHEON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:410 WEST CLINTON STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2623
Mailing Address - Country:US
Mailing Address - Phone:251-246-2350
Mailing Address - Fax:
Practice Address - Street 1:5100 RANGELINE SERVICE RD N
Practice Address - Street 2:TILLMAN'S CORNER
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9504
Practice Address - Country:US
Practice Address - Phone:251-378-4000
Practice Address - Fax:251-378-4006
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL11316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC78586OtherUPIN