Provider Demographics
NPI:1710995295
Name:HUDSON, REUBEN GUY (MD FAAP)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:GUY
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-320-4747
Practice Address - Street 1:1101 MADISON ST STE 800
Practice Address - Street 2:SWEDISH PEDIATRIC SPECIALIST CLINIC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-215-2700
Practice Address - Fax:206-215-2702
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25800208800000X
WAMD00048852208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8425738Medicaid
OR213391Medicaid
WA8425738Medicaid