Provider Demographics
NPI:1982676797
Name:HUTCHINSON, PAUL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:HUTCHINSON
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 1:2055 NORMANDIE DR
Mailing Address - Street 2:108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-288-4624
Mailing Address - Fax:334-280-3628
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:108
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-288-4624
Practice Address - Fax:334-280-3628
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000074382085R0202X
GA0139782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL108204Medicaid
AL106992Medicaid
AL106995Medicaid
AL108065Medicaid
051504364Medicare PIN
000089829Medicare PIN
000058866Medicare PIN
AL108065Medicaid
000058867Medicare PIN
051515233Medicare PIN
AL108204Medicaid