MEDICARE: DR. LAWRENCE RONALD HUTCHISON M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	33988	IA
2	207Q00000X	Family Medicine Physician	33988	IA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080169117	OTHER	GA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	12782	OTHER	IA	DEANHEALTHCARE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	IA0106	OTHER	IA	JOHN DEERE HEALTHCARE
5	1639142805	OTHER	IA	NPI
6	25104	OTHER	IA	WELLMARK BCBS NUMBER

NPI Number	:	1639142805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE RONALD HUTCHISON M.D.

Provider Business Mailing Address
First Line	:	3375 LAKE RIDGE DR
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52003-7864
Country	:	US
Telephone Number	:	563-207-8932
Fax Number	:	563-207-8935

Provider Business Practice Location Address
First Line	:	3375 LAKE RIDGE DR
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52003-7864
Country	:	US
Telephone Number	:	563-207-8932
Fax Number	:	563-207-8935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/10/2019

3395 LAKE RIDGE DR
DUBUQUE, IA
52003-7864

Practice Phone: 563-589-9119
Practice Fax: 563-552-2800