Provider Demographics
NPI:1437119633
Name:HUTSON, DARRELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:J
Last Name:HUTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2475
Mailing Address - Country:US
Mailing Address - Phone:318-214-4401
Mailing Address - Fax:318-214-4651
Practice Address - Street 1:501 KEYSER AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-214-4830
Practice Address - Fax:318-214-4651
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024254207R00000X
LAMD.024254208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00014284OtherRAILROAD MEDICARE
LA1571504Medicaid
LA1571504Medicaid
720994575OtherTAX ID
P00014284OtherRAILROAD MEDICARE