Provider Demographics
NPI:1598479297
Name:HUTSON, DANIEL B (PAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:HUTSON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1130 NW 22ND AVE STE 640
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2993
Mailing Address - Country:US
Mailing Address - Phone:503-229-7976
Mailing Address - Fax:503-274-4867
Practice Address - Street 1:4224 NE HALSEY ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1568
Practice Address - Country:US
Practice Address - Phone:503-235-5509
Practice Address - Fax:503-235-5335
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORPA153460363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical