Healthcare Provider Details

I. General information

NPI: 1770653305
Provider Name (Legal Business Name): WILLIAM B HUTCHINSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD #890W
SANTA MONICA CA
90404-2102
US

IV. Provider business mailing address

2001 SANTA MONICA BLVD #890W
SANTA MONICA CA
90404-2102
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-1786
  • Fax: 310-584-9992
Mailing address:
  • Phone: 310-453-1786
  • Fax: 310-584-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA25923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: