Healthcare Provider Details

I. General information

NPI: 1629091988
Provider Name (Legal Business Name): GRANT FARLEY HUTCHINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 INDIAN HILLS DR SUITE 200
OMAHA NE
68114-4032
US

IV. Provider business mailing address

8901 INDIAN HILLS DR SUITE 200
OMAHA NE
68114-4032
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-7057
  • Fax: 402-505-4738
Mailing address:
  • Phone: 402-397-7057
  • Fax: 402-505-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMFC1593
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20778
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: