Healthcare Provider Details

I. General information

NPI: 1871898585
Provider Name (Legal Business Name): MATTHEW HUTCHISON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 W BAY DR SUITE 401 & 402
LARGO FL
33770-2282
US

IV. Provider business mailing address

1345 W BAY DR STE 401
LARGO FL
33770-2264
US

V. Phone/Fax

Practice location:
  • Phone: 813-855-8450
  • Fax:
Mailing address:
  • Phone: 727-819-4411
  • Fax: 727-223-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS12596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: