Provider Demographics
NPI:1124008388
Name:HUDSON, GEORGE MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1537 S ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8957
Mailing Address - Country:US
Mailing Address - Phone:407-203-3888
Mailing Address - Fax:321-235-0971
Practice Address - Street 1:1537 S ALAFAYA TRL STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8955
Practice Address - Country:US
Practice Address - Phone:407-203-3888
Practice Address - Fax:321-235-0971
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1124008388Medicaid