Healthcare Provider Details

I. General information

NPI: 1134241060
Provider Name (Legal Business Name): RYAN DEAN HUTFLESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 01/14/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

8 LAKEVILLE RD APT 5
BOSTON MA
02130-2038
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number224901
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: