Healthcare Provider Details

I. General information

NPI: 1295711562
Provider Name (Legal Business Name): RICHARD GLEN HUTCHISON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LINCOLN BLVD
OKLAHOMA CITY OK
73104-3252
US

IV. Provider business mailing address

11364 QUEENSLAND CT
MIDWEST CITY OK
73130-8238
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5582
  • Fax:
Mailing address:
  • Phone: 405-259-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1579
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: