Provider Demographics
NPI:1144500554
Name:HUTCHESON, JONATHAN JUSTIN (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JUSTIN
Last Name:HUTCHESON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4097
Mailing Address - Country:US
Mailing Address - Phone:937-435-9013
Mailing Address - Fax:937-435-1458
Practice Address - Street 1:979 CONGRESS PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-435-9013
Practice Address - Fax:937-435-1458
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.012375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0191094Medicaid