Provider Demographics
NPI:1962815456
Name:HUTTER, DAWN (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:HUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W FRONT ST
Mailing Address - Street 2:STE 2
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1173
Mailing Address - Country:US
Mailing Address - Phone:870-541-6000
Mailing Address - Fax:
Practice Address - Street 1:4010 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7000
Practice Address - Country:US
Practice Address - Phone:870-541-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9584207Q00000X
NJ25MA10217100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine