Provider Demographics
NPI:1962463547
Name:HUDSON, MARK J (MD)
Entity Type:Individual
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First Name:MARK
Middle Name:J
Last Name:HUDSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:35-121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVE
Practice Address - Street 2:401
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6750
Practice Address - Fax:651-220-6770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN45433208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17008Medicare UPIN