Provider Demographics
NPI:1699853002
Name:HUTSON, ROBERT H III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:HUTSON
Suffix:III
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 1:830 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-2291
Mailing Address - Country:US
Mailing Address - Phone:330-684-2015
Mailing Address - Fax:330-684-2075
Practice Address - Street 1:830 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2291
Practice Address - Country:US
Practice Address - Phone:330-684-2015
Practice Address - Fax:330-684-2075
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1093893497OtherGROUP NPI
OH0422028Medicaid
OHF04088Medicare UPIN