Provider Demographics
NPI:1619955432
Name:HUDMAN, JENNIFER MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:HUDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:604 SOUTHEAST PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3453
Mailing Address - Country:US
Mailing Address - Phone:817-270-2320
Mailing Address - Fax:817-270-2320
Practice Address - Street 1:909 SOUTHEAST PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3693
Practice Address - Country:US
Practice Address - Phone:817-237-9225
Practice Address - Fax:817-237-9363
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175887201Medicaid
TXI43679Medicare UPIN