Provider Demographics
NPI:1477649036
Name:HUDSON, CARMEN KIMBERLY BAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:KIMBERLY BAKER
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:KIMBERLY
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:360 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4302
Mailing Address - Country:US
Mailing Address - Phone:206-310-9576
Mailing Address - Fax:206-310-9576
Practice Address - Street 1:1775 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2198
Practice Address - Country:US
Practice Address - Phone:541-269-8111
Practice Address - Fax:541-269-8517
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60076645207Q00000X
ORMD187023207Q00000X, 208600000X
TXT4936208600000X
WAMD 60076645208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine