Provider Demographics
NPI:1396771846
Name:HUTCHINSON, MYRIAM DEJESUS (MD)
Entity type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:DEJESUS
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1010 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5445
Mailing Address - Country:US
Mailing Address - Phone:337-406-2652
Mailing Address - Fax:337-893-0403
Practice Address - Street 1:104 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4039
Practice Address - Country:US
Practice Address - Phone:337-893-2438
Practice Address - Fax:337-893-0403
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4A029Medicaid
LAH27348Medicare UPIN
LA1148690Medicare ID - Type Unspecified