Provider Demographics
NPI:1356331136
Name:HUDKINS, MATTHEW GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GREGORY
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 1:8401 JACK FINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-3017
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:
Practice Address - Street 1:7710T CHERRY PARK DR # 522
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2725
Practice Address - Country:US
Practice Address - Phone:877-572-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0252612085R0202X
ARE47742085R0202X
TXM41762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200101090AMedicaid
MO135633136Medicaid
TX156506103Medicaid
AR161953001Medicaid
AR161953001Medicaid
OK200101090AMedicaid
AR5N653G180Medicare PIN
TX156506103Medicaid