Provider Demographics
NPI:1528058930
Name:HUTTON, SCOT W (MD)
Entity type:Individual
Prefix:
First Name:SCOT
Middle Name:W
Last Name:HUTTON
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-240-2205
Mailing Address - Fax:320-229-5174
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-240-2205
Practice Address - Fax:320-229-5174
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23342207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100007122OtherRR MEDICARE
2114017OtherFIRST HEALTH PLAN
110903OtherU CARE
2900208OtherMEDICA HEALTH PLANS
600899OtherARAZ GROUP AMERICAS PPO
HP25454OtherHEALTH PARTNERS
510RIHUOtherBCBS
986012OtherPREFERRED ONE
916390500OtherMEDICAL ASSISTANCE
6D069HUOtherBCBS
2114017OtherFIRST HEALTH PLAN
6D069HUOtherBCBS