MEDICARE: PAMELA JESSE HUTT 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	2080P0207X	Pediatric Hematology & Oncology Physician	35623	CO

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932159522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA JESSE HUTT M.D.

Provider Business Mailing Address
First Line	:	11 ANIMAS PL
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-4339
Country	:	US
Telephone Number	:	970-259-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MERCADO STREET - SUITE 100
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-7300
Country	:	US
Telephone Number	:	970-385-7977
Fax Number	:	970-385-6727

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/07/2010

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