Basic Information
Provider Information
NPI: 1235128059
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CUTLER
FirstName: ADAM
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 900 S PINE ISLAND RD
Address2: STE 800
City: PLANTATION
State: FL
PostalCode: 333243920
CountryCode: US
TelephoneNumber: 5614777700
FaxNumber: 5614777707
Practice Location
Address1: 19615 STATE ROAD 7
Address2: SUITE 32
City: BOCA RATON
State: FL
PostalCode: 334984700
CountryCode: US
TelephoneNumber: 5614777700
FaxNumber: 5614777707
Other Information
ProviderEnumerationDate: 10/14/2005
LastUpdateDate: 10/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XME74514FLY Allopathic & Osteopathic PhysiciansPediatrics 

ID Information
IDTypeStateIssuerDescription
25766270005FL MEDICAID


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