MEDICARE: JOHN STAFFORD HUTTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35-080545	OH
2	208000000X	Pediatrics Physician	U5004	TX

General Provider Information

NPI Number	:	1073717948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN STAFFORD HUTTON M.D.

Provider Business Mailing Address
First Line	:	2350 N STEMMONS FWY STE F2400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-2700
Country	:	US
Telephone Number	:	469-488-7100
Fax Number	:	469-488-7101

Provider Business Practice Location Address
First Line	:	2350 N STEMMONS FWY STE F2400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-2700
Country	:	US
Telephone Number	:	469-488-7100
Fax Number	:	469-488-7101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	10/03/2023

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