Provider Demographics
NPI:1598813230
Name:HUTCHERSON, ROBERT WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WESLEY
Last Name:HUTCHERSON
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 1:9675 BRIGHTON WAY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5100
Mailing Address - Country:US
Mailing Address - Phone:310-276-7012
Mailing Address - Fax:310-274-5530
Practice Address - Street 1:9675 BRIGHTON WAY
Practice Address - Street 2:SUITE 410
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5100
Practice Address - Country:US
Practice Address - Phone:310-276-7012
Practice Address - Fax:310-274-5530
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG340112086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45756Medicare UPIN