Provider Demographics
NPI:1396730339
Name:HOO, HUDMAN A JR (MD)
Entity type:Individual
Prefix:
First Name:HUDMAN
Middle Name:A
Last Name:HOO
Suffix:JR
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 1:2639 DR. M.L.KING JR. STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2733
Mailing Address - Country:US
Mailing Address - Phone:727-822-6661
Mailing Address - Fax:727-823-1334
Practice Address - Street 1:2639 DR. M.L.KING JR. STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2733
Practice Address - Country:US
Practice Address - Phone:727-822-6661
Practice Address - Fax:727-823-1334
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73085207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252582800Medicaid
FLF80160Medicare UPIN
FLF80160Medicare UPIN