Provider Demographics
NPI:1487626008
Name:HUDSON, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
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 1:5508 PARKCREST DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4914
Mailing Address - Country:US
Mailing Address - Phone:512-420-9900
Mailing Address - Fax:512-420-9944
Practice Address - Street 1:5508 PARKCREST DR
Practice Address - Street 2:SUITE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4914
Practice Address - Country:US
Practice Address - Phone:512-420-9900
Practice Address - Fax:512-420-9944
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD09152084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138111314Medicaid
TXTXB165366Medicare PIN