Provider Demographics
NPI:1336107127
Name:HUDGENS, H. STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:H.
Middle Name:STEPHEN
Last Name:HUDGENS
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 1:800 EIGHTH AVENUE-SUITE 510
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-332-5714
Mailing Address - Fax:817-338-0402
Practice Address - Street 1:800 EIGHTH AVENUE-SUITE 510
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-332-5714
Practice Address - Fax:817-338-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110266705Medicaid
TX8HW638OtherBCBSTX
TX1102667-03Medicaid