Healthcare Provider Details

I. General information

NPI: 1730163700
Provider Name (Legal Business Name): JOHN W HUTCHESON JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

IV. Provider business mailing address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8353
  • Fax: 850-474-8504
Mailing address:
  • Phone: 850-474-8353
  • Fax: 850-474-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0003551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: