Provider Demographics
NPI:1649289927
Name:HUDSON, SUSAN B (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:ALTUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:705 GENERATIONS DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0007
Mailing Address - Country:US
Mailing Address - Phone:830-608-8004
Mailing Address - Fax:830-620-9077
Practice Address - Street 1:705 GENERATIONS DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0007
Practice Address - Country:US
Practice Address - Phone:830-608-8004
Practice Address - Fax:830-620-9077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9256207VE0102X
MN49153207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN267102000Medicaid
MN267102000Medicaid
MN160002591Medicare ID - Type Unspecified
MN160002952Medicare PIN