Healthcare Provider Details

I. General information

NPI: 1487220125
Provider Name (Legal Business Name): MARY OLIVIA HUTTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9137 RIDGELINE BLVD STE 100
HIGHLANDS RANCH CO
80129-2397
US

IV. Provider business mailing address

9137 RIDGELINE BLVD STE 100
HIGHLANDS RANCH CO
80129-2397
US

V. Phone/Fax

Practice location:
  • Phone: 303-649-3140
  • Fax:
Mailing address:
  • Phone: 303-649-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number196-T2
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.73265
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: