Individual
TIMOTHY R. DUTTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1787
(864) 222-8575
Mailing address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1417
(864) 512-1823
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A759
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393510150A
—
GA
05
—
QM0668
—
SC
Enumeration date
04/27/2006
Last updated
05/30/2012
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