Healthcare Provider Details

I. General information

NPI: 1174510218
Provider Name (Legal Business Name): FRED P. DUTTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT STREET EMERGENCY DEPARTMENT
CONCORD NH
03301-2598
US

IV. Provider business mailing address

250 PLEASANT STREET EMERGENCY DEPARTMENT
CONCORD NH
03301-2598
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2711
  • Fax: 603-224-6527
Mailing address:
  • Phone: 603-225-2711
  • Fax: 603-224-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2002027887
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18656
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: