Healthcare Provider Details

I. General information

NPI: 1992155030
Provider Name (Legal Business Name): ELAINE JOYCE HUTCHISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 04/02/2024
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-652-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019022595
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: