Provider Demographics
NPI:1003081928
Name:HUDSON, TAMARA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:SUZANNE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5730
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5730
Mailing Address - Country:US
Mailing Address - Phone:505-867-2324
Mailing Address - Fax:505-771-3431
Practice Address - Street 1:121 CALLE DEL PRESIDENTE
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6091
Practice Address - Country:US
Practice Address - Phone:505-867-2324
Practice Address - Fax:505-771-3431
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2011-0160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine