Healthcare Provider Details

I. General information

NPI: 1649572306
Provider Name (Legal Business Name): MILES A. HUTSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 AVENUE E
HONDO TX
78861-3525
US

IV. Provider business mailing address

1600 11TH ST
WICHITA FALLS TX
76301-4300
US

V. Phone/Fax

Practice location:
  • Phone: 830-426-7444
  • Fax: 830-426-7468
Mailing address:
  • Phone: 940-764-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE9708
License Number StateTX

VIII. Authorized Official

Name: DR. MILES HUTSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 830-426-7444