Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 01065968A | IN |
N | 207RC0200X | Critical Care Medicine | ME143571 | FL |
NPI | 1073603155 |
---|---|
Provider Name | William G. Hutchison |
First Address | Lafayette, IN 47903-5545 |
Second Address | Lafayette, IN 47904-2477 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000598089 | ANTHEM PROVIDER NUMBER (01) | IN |
PENDING | (05) | IN |