Provider Demographics
NPI:1013994144
Name:HUDSON, JAMES MELVIN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MELVIN
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 DADRIAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1685
Mailing Address - Country:US
Mailing Address - Phone:618-433-5005
Mailing Address - Fax:618-467-1053
Practice Address - Street 1:1310 DADRIAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1685
Practice Address - Country:US
Practice Address - Phone:618-433-5005
Practice Address - Fax:618-467-1053
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058812207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058812Medicaid
ILP00069175OtherMEDICARE RR
K03682Medicare PIN
ILP00069175OtherMEDICARE RR
IL0553590001Medicare NSC