| Doctor Name: | DR. ELIZABETH MARGARET MUTCH |
| NPI Number: | 1801022009 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | ME 42969 |
| Business Practice Address: | 986 Wendam Ct Port Orange, FL - 321279331 |
| Business Phone Number: | 3867670669 |
| Business Fax Number: | 3867670669 |
| Mailing Address: | 986 Wendam Ct, PORT ORANGE |
| State: | FL |
| Postal Code: | 321279331 |
| Phone Number: | 3867670669 |
| Fax Number: | 3867670669 |
| NPI Enumeration Date: | 06/02/2009 |
| NPI Last Update Date: | 06/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 42969 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |