Provider Demographics
NPI:1871540955
Name:HUTSON, SCOTT B (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:HUTSON
Suffix:
Gender:M
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:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0309
Mailing Address - Country:US
Mailing Address - Phone:509-525-4900
Mailing Address - Fax:509-522-3886
Practice Address - Street 1:1017 S 2ND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4116
Practice Address - Country:US
Practice Address - Phone:509-525-4900
Practice Address - Fax:509-522-3886
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019935207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021011Medicaid
WA1021011Medicaid
WAG8925329Medicare PIN
WA911297635OtherBCBS
WAA09380Medicare UPIN