Healthcare Provider Details

I. General information

NPI: 1558394676
Provider Name (Legal Business Name): TIMOTHY J HUTCHISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIM HUTCHISON M.D.

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

PO BOX 912215
DENVER CO
80291-2215
US

V. Phone/Fax

Practice location:
  • Phone: 303-306-7783
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number30096
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30096
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: