Healthcare Provider Details

I. General information

NPI: 1912946021
Provider Name (Legal Business Name): GEORGE ROBERT HUTCHISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17105 HUNTING VALLEY RD
ROLAND AR
72135
US

IV. Provider business mailing address

PO BOX 60
ROLAND AR
72135-0060
US

V. Phone/Fax

Practice location:
  • Phone: 501-944-7417
  • Fax: 501-868-6361
Mailing address:
  • Phone: 501-944-7417
  • Fax: 501-868-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR4171
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberR4171
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: