Provider Demographics
NPI:1588615173
Name:HUTCHINSON, KEITH B (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:B
Last Name:HUTCHINSON
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 1:2800 W PACK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1195
Mailing Address - Country:US
Mailing Address - Phone:505-350-8207
Mailing Address - Fax:928-773-1170
Practice Address - Street 1:1200 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-773-0003
Practice Address - Fax:928-773-1170
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2003-0715207R00000X
AZ50304207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ660740Medicaid
NM93839871Medicaid
AZ660740Medicaid
NM93839871Medicaid
I54931Medicare UPIN