Provider Demographics
NPI:1447413877
Name:HUTSON, LAWRENCE TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:TIMOTHY
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 1:929 W SPRESSER ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1831
Mailing Address - Country:US
Mailing Address - Phone:217-287-7969
Mailing Address - Fax:217-287-1478
Practice Address - Street 1:929 W SPRESSER ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1831
Practice Address - Country:US
Practice Address - Phone:217-287-7969
Practice Address - Fax:217-287-1478
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-021379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist