Healthcare Provider Details

I. General information

NPI: 1881636702
Provider Name (Legal Business Name): TIMOTHY W HUTCHISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 S GRAND BLVD
SAINT LOUIS MO
63118-3405
US

IV. Provider business mailing address

3721 S GRAND BLVD
SAINT LOUIS MO
63118-3405
US

V. Phone/Fax

Practice location:
  • Phone: 314-328-0144
  • Fax:
Mailing address:
  • Phone: 314-328-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101241398
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101241398
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024000917
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number104721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: