Healthcare Provider Details

I. General information

NPI: 1033189972
Provider Name (Legal Business Name): RONALD GENE HUTSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E 5TH AVE
RANSON WV
25438-1770
US

IV. Provider business mailing address

101 DARTMOUTH LN
FALLING WATERS WV
25419-3972
US

V. Phone/Fax

Practice location:
  • Phone: 304-724-7417
  • Fax: 304-724-7418
Mailing address:
  • Phone: 304-274-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: