Provider Demographics
NPI:1053406686
Name:MCCUTCHEN, JEFFREY ROBET (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBET
Last Name:MCCUTCHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-283-8193
Mailing Address - Fax:704-283-7252
Practice Address - Street 1:613 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5124
Practice Address - Country:US
Practice Address - Phone:704-283-8193
Practice Address - Fax:704-283-7252
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002717207Q00000X
NC2009-00328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911517Medicaid
NC1053406686Medicaid
OH527460Medicaid
SC012328Medicaid
NCNC5031BMedicare PIN
F01451Medicare UPIN
NC2073256NMedicare PIN
NC2073256PMedicare PIN
NCNC5031AMedicare PIN
NC2073256AMedicare PIN
NC2073256HMedicare PIN
NC2073256MMedicare PIN
NC5911517Medicaid
NC2073256JMedicare PIN
SCAA48077772Medicare PIN
NC2073256BMedicare PIN
NCNC50310386Medicare PIN
NC2073256EMedicare PIN
OH527460Medicaid
NC1053406686Medicaid
NC2073256GMedicare PIN
NCNC5031CMedicare PIN