Provider Demographics
NPI:1134312895
Name:HUDSON, TIMOTHY B (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
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 1:2901 OHIO BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2239
Mailing Address - Country:US
Mailing Address - Phone:812-232-2144
Mailing Address - Fax:812-234-4598
Practice Address - Street 1:2901 OHIO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2239
Practice Address - Country:US
Practice Address - Phone:812-232-2144
Practice Address - Fax:812-234-4598
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030316A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100239430BMedicaid
IN100239430BMedicaid