Provider Demographics
NPI:1245229657
Name:HUDKINS, BRUCE E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:HUDKINS
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 1:6802 S OLYMPIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1826
Mailing Address - Country:US
Mailing Address - Phone:918-388-2398
Mailing Address - Fax:918-388-2419
Practice Address - Street 1:6802 S OLYMPIA AVE WEST
Practice Address - Street 2:STE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132
Practice Address - Country:US
Practice Address - Phone:918-388-2398
Practice Address - Fax:918-388-2419
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20122207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
248427904Medicare ID - Type Unspecified
OKG52683Medicare UPIN