Provider Demographics
NPI:1841255569
Name:CULTON, MARK ANDERSON (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDERSON
Last Name:CULTON
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 1:7254 CLUNIE PL APT 15004
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3264
Mailing Address - Country:US
Mailing Address - Phone:408-656-0850
Mailing Address - Fax:
Practice Address - Street 1:7254 CLUNIE PL APT 15004
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3264
Practice Address - Country:US
Practice Address - Phone:408-656-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1507572085R0202X
WY12166C2085R0202X
COCDRH.00627182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF51061Medicare UPIN