Provider Demographics
NPI:1184634537
Name:HUDSON, JOHN LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LAWRENCE
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11750 W 2ND PL
Mailing Address - Street 2:STE 255
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1575
Mailing Address - Country:US
Mailing Address - Phone:720-321-8040
Mailing Address - Fax:720-321-8041
Practice Address - Street 1:11750 W 2ND PL
Practice Address - Street 2:STE 255
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1575
Practice Address - Country:US
Practice Address - Phone:720-321-8040
Practice Address - Fax:720-321-8041
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO38437207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41526830Medicaid
CO41526830Medicaid
C443568Medicare ID - Type Unspecified