Provider Demographics
NPI:1760402598
Name:HUTTON, CONNIE C
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:C
Last Name:HUTTON
Suffix:
Gender:M
Credentials:
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 404554
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4554
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:615-373-7651
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:300
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2889
Practice Address - Country:US
Practice Address - Phone:936-539-5000
Practice Address - Fax:936-539-5027
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9506208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D6623Medicare PIN