Provider Demographics
NPI:1932159522
Name:HUTT, PAMELA JESSE (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JESSE
Last Name:HUTT
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 1:11 ANIMAS PL
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4339
Mailing Address - Country:US
Mailing Address - Phone:970-259-8308
Mailing Address - Fax:
Practice Address - Street 1:1 MERCADO STREET - SUITE 100
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-385-7977
Practice Address - Fax:970-385-6727
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO356232080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS3993Medicaid
AZ947848Medicaid
UTT1024Medicaid
CO01356237Medicaid
COF41962Medicare UPIN
NMS3993Medicaid