Healthcare Provider Details

I. General information

NPI: 1932159522
Provider Name (Legal Business Name): PAMELA JESSE HUTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO STREET - SUITE 100
DURANGO CO
81301-7300
US

IV. Provider business mailing address

11 ANIMAS PL
DURANGO CO
81301-4339
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-7977
  • Fax: 970-385-6727
Mailing address:
  • Phone: 970-259-8308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number35623
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: