Provider Demographics
NPI:1760427702
Name:HUDSON, LISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:913 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 186
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4031
Mailing Address - Country:US
Mailing Address - Phone:925-984-2622
Mailing Address - Fax:925-362-3676
Practice Address - Street 1:913 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 186
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4031
Practice Address - Country:US
Practice Address - Phone:925-984-2622
Practice Address - Fax:925-362-3676
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG77153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01114645OtherRAILROAD MEDICARE
CA00G771530Medicaid
CA00G771530Medicaid
CA110117178Medicare PIN
CABG878ZMedicare PIN