Provider Demographics
NPI:1508861857
Name:HUTTNER, JAMES JACOB (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JACOB
Last Name:HUTTNER
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 1:520 W SOPHIA ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1848
Mailing Address - Country:US
Mailing Address - Phone:419-893-1880
Mailing Address - Fax:419-893-1242
Practice Address - Street 1:520 W SOPHIA ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1848
Practice Address - Country:US
Practice Address - Phone:419-893-1880
Practice Address - Fax:419-893-1242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
OH35050403H208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics