MEDICARE: DR. FRED P. DUTTON MD

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	207P00000X	Emergency Medicine Physician	2002027887	MO
2	207P00000X	Emergency Medicine Physician	18656	NH

General Provider Information

NPI Number	:	1174510218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED P. DUTTON MD

Provider Business Mailing Address
First Line	:	250 PLEASANT STREET
Second Line	:	EMERGENCY DEPARTMENT
City	:	CONCORD
State	:	NH
Zip	:	03301-2598
Country	:	US
Telephone Number	:	603-225-2711
Fax Number	:	603-224-6527

Provider Business Practice Location Address
First Line	:	250 PLEASANT STREET
Second Line	:	EMERGENCY DEPARTMENT
City	:	CONCORD
State	:	NH
Zip	:	03301-2598
Country	:	US
Telephone Number	:	603-225-2711
Fax Number	:	603-224-6527

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	11/06/2018

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