Provider Demographics
NPI:1972506186
Name:HUTSON, RODNEY KENT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:KENT
Last Name:HUTSON
Suffix:JR
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 483
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-0483
Mailing Address - Country:US
Mailing Address - Phone:615-440-6937
Mailing Address - Fax:
Practice Address - Street 1:140 STAR VIEW CIR # 483
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-5129
Practice Address - Country:US
Practice Address - Phone:615-440-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD269602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3852356Medicaid
TN3852356Medicare ID - Type Unspecified
TNF50742Medicare UPIN