Healthcare Provider Details

I. General information

NPI: 1346293461
Provider Name (Legal Business Name): CLINTON T HUTCHINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 KANIS RD STE 200
LITTLE ROCK AR
72205-6324
US

IV. Provider business mailing address

9500 KANIS RD STE 200
LITTLE ROCK AR
72205-6324
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-6699
  • Fax: 501-224-7752
Mailing address:
  • Phone: 501-224-6699
  • Fax: 501-224-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE-4923
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: