Provider Demographics
NPI:1598178634
Name:HUTCHINSON, DWIGHT (BS)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 VIEW RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3545
Mailing Address - Country:US
Mailing Address - Phone:407-375-8685
Mailing Address - Fax:
Practice Address - Street 1:2441 VIEW RIDGE WAY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3545
Practice Address - Country:US
Practice Address - Phone:407-375-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL805025876OtherFARS
FL802030361OtherCFARS