Healthcare Provider Details

I. General information

NPI: 1285600346
Provider Name (Legal Business Name): JOHN P DUTTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

8185 WINTERHAWK LN
GRANITE BAY CA
95746-9018
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3826
  • Fax:
Mailing address:
  • Phone: 916-787-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60861174
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC52209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: