Provider Demographics
NPI:1497935175
Name:HUDEC, BRADLEY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WAYNE
Last Name:HUDEC
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 1:1008 259TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-4919
Mailing Address - Country:US
Mailing Address - Phone:360-629-9370
Mailing Address - Fax:
Practice Address - Street 1:4320 196TH ST SW STE D
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6753
Practice Address - Country:US
Practice Address - Phone:425-774-8758
Practice Address - Fax:425-672-8944
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine