Provider Demographics
NPI:1265416689
Name:HUTSELL, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:HUTSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13601 PRESTON ROAD
Mailing Address - Street 2:1000W
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4911
Mailing Address - Country:US
Mailing Address - Phone:972-663-8523
Mailing Address - Fax:972-663-8329
Practice Address - Street 1:23900 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1323
Practice Address - Country:US
Practice Address - Phone:281-644-7207
Practice Address - Fax:281-644-7208
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4456207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3768OtherBLUE CTOSS/BLUE SHIELD
TX163666401Medicaid
TXP00112621OtherRAILROAD MEDICARE
TX8B3425Medicare ID - Type Unspecified
H99920Medicare UPIN
TX8J3768OtherBLUE CTOSS/BLUE SHIELD