Individual
GARY THOMAS MUTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
117 E KINGS HWY, EDEN, NC 27288-5201
(336) 623-9711
(336) 623-7660
Mailing address
117 E KINGS HWY, EDEN, NC 27288-5201
(336) 623-9711
(336) 623-7660
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19870
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6056601
—
VA
05
—
8961636
—
NC
Enumeration date
07/12/2006
Last updated
12/14/2007
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