Provider Demographics
NPI:1679530372
Name:HUDELSON, MARY BRANDT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BRANDT
Last Name:HUDELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3051 CHURCHILL DR
Mailing Address - Street 2:STE 130
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2710
Mailing Address - Country:US
Mailing Address - Phone:972-539-0086
Mailing Address - Fax:972-355-9680
Practice Address - Street 1:3051 CHURCHILL DR
Practice Address - Street 2:STE 130
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2710
Practice Address - Country:US
Practice Address - Phone:972-539-0086
Practice Address - Fax:972-355-9680
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4184207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82391SOtherBC/BS
TXAETNAOther4378428
TX030003804OtherRAILROAD MEDICARE
TXAETNAOther4378428
TX83260KMedicare PIN