MEDICARE: KIRK STEVEN DUTTON M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	E9613	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	282857	OTHER	TX	VALUE OPTIONS
3	007250000	OTHER	TX	MAGELLAN BEHAVIORAL
4	000000LM23	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1861494700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK STEVEN DUTTON M.D.

Provider Business Mailing Address
First Line	:	1316 WASHINGTON AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1129
Country	:	US
Telephone Number	:	254-776-1421
Fax Number	:	254-776-1711

Provider Business Practice Location Address
First Line	:	1316 WASHINGTON AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1129
Country	:	US
Telephone Number	:	254-776-1421
Fax Number	:	254-776-1711

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/22/2011

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