Provider Demographics
NPI:1902978075
Name:HUTCHESON, BRIAN P (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:HUTCHESON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 E CAMP LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1276
Mailing Address - Country:US
Mailing Address - Phone:520-881-8640
Mailing Address - Fax:520-881-0332
Practice Address - Street 1:4816 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1276
Practice Address - Country:US
Practice Address - Phone:520-881-8640
Practice Address - Fax:520-881-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0456213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU62220Medicare UPIN