Provider Demographics
NPI:1467709212
Name:HUDSON, HAROLD KEELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:KEELEN
Last Name:HUDSON
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 1:1488 COLUMBINE DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6975
Mailing Address - Country:US
Mailing Address - Phone:662-842-1936
Mailing Address - Fax:
Practice Address - Street 1:1488 COLUMBINE DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6975
Practice Address - Country:US
Practice Address - Phone:662-842-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05279207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology