Healthcare Provider Details

I. General information

NPI: 1417947482
Provider Name (Legal Business Name): JAMES PHILIP HUTTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE STE 404
TULSA OK
74104-5638
US

IV. Provider business mailing address

1515 N HARVARD AVE STE E
TULSA OK
74115-4957
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3424
  • Fax: 918-744-3622
Mailing address:
  • Phone: 918-832-6049
  • Fax: 918-832-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number14704
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberF4105
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: