Provider Demographics
NPI:1699700104
Name:HUTSON, MILES A (MD)
Entity type:Individual
Prefix:MR
First Name:MILES
Middle Name:A
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 858
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-0858
Mailing Address - Country:US
Mailing Address - Phone:830-741-4331
Mailing Address - Fax:830-741-6270
Practice Address - Street 1:3200 AVENUE E
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861
Practice Address - Country:US
Practice Address - Phone:830-741-4331
Practice Address - Fax:830-741-6270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0047EPOtherBCBS ID
TX130927002Medicaid
TX130927003Medicaid
TX8J0360OtherBCBS
TX8J0360OtherBCBS
C17272Medicare UPIN
TX130927002Medicaid
00562LMedicare ID - Type Unspecified