Provider Demographics
NPI:1689641391
Name:HUTTO, STEPHEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:HUTTO
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:910 E HOUSTON ST
Practice Address - Street 2:STE 550
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8369
Practice Address - Country:US
Practice Address - Phone:903-510-8718
Practice Address - Fax:903-525-1218
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4863207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-008OtherTRICARE
TX152564401Medicaid
TX8FH270OtherBCBS
TXP01536078OtherRAIL ROAD
TX0013JEOtherBLUE CROSS BLUE SHIELD
TX75-2616977-125OtherTRICARE
TX100016832OtherRAILROAD MCR
TX132297608Medicaid
TX0013JEOtherBLUE CROSS BLUE SHIELD
TX827086Medicare PIN
TXP01536078OtherRAIL ROAD