Healthcare Provider Details

I. General information

NPI: 1639142805
Provider Name (Legal Business Name): LAWRENCE RONALD HUTCHISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 LAKE RIDGE DR
DUBUQUE IA
52003-7864
US

IV. Provider business mailing address

3375 LAKE RIDGE DR
DUBUQUE IA
52003-7864
US

V. Phone/Fax

Practice location:
  • Phone: 563-207-8932
  • Fax: 563-207-8935
Mailing address:
  • Phone: 563-207-8932
  • Fax: 563-207-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33988
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33988
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: