1649289927 NPI number — DR. SUSAN B HUDSON M.D.

Table of content: (NPI 1477883882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649289927 NPI number — DR. SUSAN B HUDSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDSON
Provider First Name:
SUSAN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALTUM
Provider Other First Name:
SUSAN
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649289927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 GENERATIONS DRIVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78130-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-608-8004
Provider Business Mailing Address Fax Number:
830-620-9077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 GENERATIONS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-0007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-608-8004
Provider Business Practice Location Address Fax Number:
830-620-9077
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  L9256 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 267102000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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