Healthcare Provider Details

I. General information

NPI: 1508840083
Provider Name (Legal Business Name): PAUL H HUTSCHENREUTER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 S ORANGE AVE
ORLANDO FL
32806-6216
US

IV. Provider business mailing address

3615 S ORANGE AVE
ORLANDO FL
32806-6216
US

V. Phone/Fax

Practice location:
  • Phone: 407-855-2526
  • Fax: 407-855-1503
Mailing address:
  • Phone: 407-855-2526
  • Fax: 407-855-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: