Provider Demographics
NPI:1639517196
Name:HUDSON, IAN LAURENCE (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:LAURENCE
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
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Mailing Address - Street 1:323 TRAFALGAR RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5133
Mailing Address - Country:US
Mailing Address - Phone:760-799-9972
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004690A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN