Provider Demographics
NPI:1013165612
Name:HUTTO, JOHN MAHLON
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MAHLON
Last Name:HUTTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:HUTTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1485 FESTIVAL LN
Mailing Address - Street 2:
Mailing Address - City:BRUTUS
Mailing Address - State:MI
Mailing Address - Zip Code:49716-9500
Mailing Address - Country:US
Mailing Address - Phone:231-529-6925
Mailing Address - Fax:
Practice Address - Street 1:1485 FESTIVAL LN
Practice Address - Street 2:
Practice Address - City:BRUTUS
Practice Address - State:MI
Practice Address - Zip Code:49716-9500
Practice Address - Country:US
Practice Address - Phone:231-529-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18161207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology