Individual
DR. SCOTT BRADLEY MUTCHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
Mailing address
400 EAST THIRD STREET, MCL2CRED, DULUTH, MN 55805-1951
(218) 786-1183
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
5699
ND
208M00000X
Hospitalist Physician
5699
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202065421
—
MO
05
—
269757200
—
FL
Enumeration date
06/24/2006
Last updated
10/11/2018
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