Healthcare Provider Details

I. General information

NPI: 1093982472
Provider Name (Legal Business Name): DOUGLAS EDWARD HUTCHINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 E GWINN PL
SEATTLE WA
98102-3811
US

IV. Provider business mailing address

877 E GWINN PL
SEATTLE WA
98102-3811
US

V. Phone/Fax

Practice location:
  • Phone: 907-455-6110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1499
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: