Healthcare Provider Details

I. General information

NPI: 1992963649
Provider Name (Legal Business Name): CAROL M HUTCHINSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 S PALO VERDE RD
TUCSON AZ
85714-1947
US

IV. Provider business mailing address

4710 S PALO VERDE RD
TUCSON AZ
85714-1947
US

V. Phone/Fax

Practice location:
  • Phone: 520-638-2000
  • Fax: 520-807-6872
Mailing address:
  • Phone: 520-638-2000
  • Fax: 520-807-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2121
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2121
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: