Provider Demographics
NPI:1558456756
Name:HUTSON, GEORGE MICHAEL (PAC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:HUTSON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2905 W WARNER RD
Mailing Address - Street 2:#12
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1674
Mailing Address - Country:US
Mailing Address - Phone:480-831-8457
Mailing Address - Fax:480-491-3112
Practice Address - Street 1:2905 W WARNER RD
Practice Address - Street 2:#12
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1674
Practice Address - Country:US
Practice Address - Phone:480-831-8457
Practice Address - Fax:480-491-3112
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35678Medicare UPIN