Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | ME21433 | FL |
NPI | 1386694172 |
---|---|
Provider Name | Dr. Jack Hoover Hutto JR. |
First Address | St Petersburg, FL 33701-4816 |
Second Address | St Petersburg, FL 33701-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D57775 | (02) | FL |