Provider Demographics
NPI:1760485825
Name:HUDAK, DEBORAH (DO)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HUDAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 E MCMURRAY BLVD
Mailing Address - Street 2:STE 132
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5934
Mailing Address - Country:US
Mailing Address - Phone:520-876-0478
Mailing Address - Fax:520-876-0484
Practice Address - Street 1:1653 E MCMURRAY BLVD
Practice Address - Street 2:STE 132
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5934
Practice Address - Country:US
Practice Address - Phone:520-876-0478
Practice Address - Fax:520-876-0484
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03-1815OtherMEDICARE
AZ441246Medicaid
ZFQ31815OtherMEDICARE
G81956Medicare UPIN