Healthcare Provider Details

I. General information

NPI: 1780079319
Provider Name (Legal Business Name): SEAN MICHAEL HUTZLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 HOSPITAL BLVD 5 WEST
CORPUS CHRISTI TX
78405
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 361-902-6570
  • Fax: 361-881-1467
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR2626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: