Healthcare Provider Details

I. General information

NPI: 1912139452
Provider Name (Legal Business Name): RICHARD LOUIS HUTCHISON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST BUILDING B, SUITE 103
FARMINGTON NM
87401-8990
US

IV. Provider business mailing address

PO BOX 5820
FARMINGTON NM
87499
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-1754
  • Fax:
Mailing address:
  • Phone: 505-327-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD2009-0471
License Number StateNM

VIII. Authorized Official

Name: RICHARD LOUIS HUTCHISON
Title or Position: PRESIDENT
Credential: MD
Phone: 505-327-1754