Provider Demographics
NPI:1609818228
Name:HUTCHINGS, RANDALL R (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:R
Last Name:HUTCHINGS
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 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-6800
Mailing Address - Fax:208-302-6855
Practice Address - Street 1:1510 12TH AVE RD
Practice Address - Street 2:STE 200
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-302-6800
Practice Address - Fax:208-302-6855
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003733600Medicaid
ID003733600Medicaid
C36940Medicare UPIN