Healthcare Provider Details

I. General information

NPI: 1033524178
Provider Name (Legal Business Name): JUSTIN T HUTCHISON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 02/19/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

1800 HARRISON ST FL 7
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5000
  • Fax:
Mailing address:
  • Phone: 209-735-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A16514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: