Individual
MARK CONRAD MUETTERTIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11 FRIENDSHIP ST, NEWPORT, RI 02840-2271
(401) 845-1593
(401) 847-0650
Mailing address
11 FRIENDSHIP ST, NEWPORT, RI 02840-2271
(401) 845-1593
(401) 847-0650
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD10743
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7057902
—
RI
01
—
U400167716
MEDICARE NGS
RI
Enumeration date
04/26/2006
Last updated
06/04/2015
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