Healthcare Provider Details

I. General information

NPI: 1083721922
Provider Name (Legal Business Name): WILLIAM STEVEN HUTTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BASICH BLVD
ABERDEEN WA
98520-1066
US

IV. Provider business mailing address

1100 BASICH BLVD
ABERDEEN WA
98520-1066
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-1950
  • Fax: 360-537-1177
Mailing address:
  • Phone: 360-532-1950
  • Fax: 360-537-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00025948
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: