Healthcare Provider Details

I. General information

NPI: 1689690950
Provider Name (Legal Business Name): LARRY D. HUTCHINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N EAGLE CREEK DR SUITE 250
LEXINGTON KY
40509-1827
US

IV. Provider business mailing address

120 N EAGLE CREEK DR SUITE 250
LEXINGTON KY
40509-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-5141
  • Fax: 859-258-5168
Mailing address:
  • Phone: 859-258-5141
  • Fax: 859-258-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20191
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: