Provider Demographics
NPI:1154680056
Name:HUDSON, TILLMAN (MD)
Entity Type:Individual
Prefix:
First Name:TILLMAN
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 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3333
Mailing Address - Country:US
Mailing Address - Phone:918-488-6687
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6585 S YALE AVE STE 720
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8320
Practice Address - Country:US
Practice Address - Phone:918-502-5930
Practice Address - Fax:918-502-5935
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565314390200000X
OK32187208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program