Provider Demographics
NPI:1912192170
Name:KARRI D.DUTTON,M.D.,P.A.
Entity Type:Organization
Organization Name:KARRI D.DUTTON,M.D.,P.A.
Other - Org Name:KIDSCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-899-5437
Mailing Address - Street 1:3871 LONG PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1569
Mailing Address - Country:US
Mailing Address - Phone:972-899-5437
Mailing Address - Fax:972-899-5447
Practice Address - Street 1:3871 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1569
Practice Address - Country:US
Practice Address - Phone:972-899-5437
Practice Address - Fax:972-899-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ6936OtherLICENSE
TX1366545709OtherNPI (INDIVIDUAL)
TXF64318OtherUPIN