Basic Information
Provider Information
NPI: 1003938986
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUTTON
FirstName: WILLIAM
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5080 SPECTRUM DRIVE
Address2: SUITE 1200 WEST TOWER
City: ADDISON
State: TX
PostalCode: 75001
CountryCode: US
TelephoneNumber: 8002323550
FaxNumber:  
Practice Location
Address1: 2410 FRANKLIN PIKE
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372042227
CountryCode: US
TelephoneNumber: 6157784066
FaxNumber: 6157789114
Other Information
ProviderEnumerationDate: 04/04/2007
LastUpdateDate: 02/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2083X0100X29342TNY Allopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine

No ID Information.


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