Provider Demographics
NPI:1376756718
Name:HUDSON, JOHN LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1044 S 88TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9417
Mailing Address - Country:US
Mailing Address - Phone:303-666-7119
Mailing Address - Fax:303-666-0220
Practice Address - Street 1:1044 S 88TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9417
Practice Address - Country:US
Practice Address - Phone:303-666-7119
Practice Address - Fax:303-666-0220
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO19771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23658Medicare UPIN
COE7118Medicare ID - Type Unspecified