Provider Demographics
NPI:1598947251
Name:GASTROENTEROLOGY OF TYLER, P.A.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY OF TYLER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-597-0202
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-597-0202
Mailing Address - Fax:903-597-0231
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE 410
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-597-0202
Practice Address - Fax:903-597-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152564401Medicaid
TX0013JEOtherBLUECROSS & BLUESHIELD
TX100016832OtherRAILROAD MEDICARE
TX00571TMedicare PIN
TX100016832OtherRAILROAD MEDICARE