Provider Demographics
NPI:1003997768
Name:HUDSON, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CONCORD MEDICAL GROUP
Practice Address - Street 2:1602 AVENUE Q
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401
Practice Address - Country:US
Practice Address - Phone:972-829-6613
Practice Address - Fax:800-611-5029
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4237207Q00000X
TXE6429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131407209Medicaid
ARP00204650OtherRAILROAD MEDICARE
TXP01176879OtherRAILROAD MEDICARE
AR157958001Medicaid
TX8DL165OtherBCBS
D66603Medicare UPIN
TXP01176879OtherRAILROAD MEDICARE
TX131407209Medicaid