MEDICARE: DR. RODNEY KENT HUTSON JR. 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	2085R0202X	Diagnostic Radiology Physician	036146046	IL
2	2085R0202X	Diagnostic Radiology Physician	MD26960	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972506186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY KENT HUTSON JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 483
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-0483
Country	:	US
Telephone Number	:	615-440-6937
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 STAR VIEW CIR # 483
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-5129
Country	:	US
Telephone Number	:	615-440-6937
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/04/2025

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