Provider Demographics
NPI:1639142805
Name:HUTCHISON, LAWRENCE RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RONALD
Last Name:HUTCHISON
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 1:3375 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7864
Mailing Address - Country:US
Mailing Address - Phone:563-207-8932
Mailing Address - Fax:563-207-8935
Practice Address - Street 1:3375 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7864
Practice Address - Country:US
Practice Address - Phone:563-207-8932
Practice Address - Fax:563-207-8935
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33988174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080169117OtherRAILROAD MEDICARE
IA12782OtherDEANHEALTHCARE NUMBER
IA1985598Medicaid
IAIA0106OtherJOHN DEERE HEALTHCARE
IA1639142805OtherNPI
IA25104OtherWELLMARK BCBS NUMBER
GA080169117OtherRAILROAD MEDICARE
IA1639142805OtherNPI