Provider Demographics
NPI:1659593341
Name:HUTCHERSON, JOHN LEE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
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 1:480 SAN BERNABE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6127
Mailing Address - Country:US
Mailing Address - Phone:831-616-9956
Mailing Address - Fax:
Practice Address - Street 1:480 SAN BERNABE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6127
Practice Address - Country:US
Practice Address - Phone:831-616-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE7922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist